NC0088714_Add Info - Form 2C Signed_20230807

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United States Office of Water EPA Form 3510-2C
Environmental Protection Agency Washington, D.C. Revised March 2019
Water Permits Division
� E�► Application Form 2C
Existing Manufacturing,
Commercial, Mining, and
Silvicultural Operations
NPDES Permitting Program
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 17t' Street, NW,
Washington, DC 20503, marked "Attention: Desk Officer for EPA."

FORM 2C—INSTRUCTIONS
General Instructions
Who Must Complete Form 2C?
You must complete Form 2C if you answered "Yes" to Item 1.2.2 on
Form 1—that is, if you are an existing manufacturing, commercial,
mining, or silvicultural facility that currently discharges process
wastewater.
Where to File Your Completed Form
Submit your completed application package (Forms 1 and 2C) to
your National Pollutant Discharge Elimination System (NPDES)
permitting authority. Consult Exhibit 1-1 of Form 1's "General
Instructions" to identify your NPDES permitting authority.
Public Availability of Submitted Information
The U.S. Environmental Protection Agency (EPA) will make
information from NPDES permit application forms available to the
public for inspection and copying upon request. You may not claim
any information on Form 2C (or related attachments) as
confidential.
You may make a claim of confidentiality for any information that you
submit to EPA that goes beyond the information required by Form
2C. Note that NPDES authorities will deny claims for treating any
effluent data as confidential. 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 40 of the Code of
Federal Regulations (CFR).
Completion of Forms
Print or type in the specified areas only. If you do not have enough
space on the form to answer a question, you may continue on
additional sheets, as necessary, using a format consistent with the
form.
Provide your EPA Identification Number from the Federal Registry
Service, NPDES permit number, and facility name at the top of
each page of Form 2C and any attachments. If you do not know
your EPA Identification Number, contact your NPDES permitting
authority. See Exhibit 1-1 of Form 1's "General Instructions" for
contact information. Additionally, for Tables A through E, provide
the applicable outfall number at the top of each page.
Do not leave any response areas blank unless the form directs you
to skip them. If the form directs you to respond to an item that does
not apply to your facility or activity, enter "NA" for "not applicable" to
show that you considered the item and determined a response was
not necessary for your facility.
The NPDES permitting authority will consider your application
complete when it and any supplementary material are received and
completed according to the authority's satisfaction. The NPDES
permitting authority will judge the completeness of any application
independently of the status of any other permit application or permit
for the same facility or activity.
Definitions
The legal definitions of all key terms used in these instructions and
Form 2C are in the "Glossary" at the end of the "General
Instructions" in Form 1.
Line -by -Line Instructions
Section 1.Outfall Location
Item 1.1. Identify each of the facility's outfall structures by number.
For each outfall, specify the latitude and longitude to the nearest
15 seconds and name of the receiving water. The application form
provides reporting space for three outfalls. If your facility has more
than this number, attach additional sheets as necessary. The
location of each outfall (i.e., where the coordinates are collected)
shall be the point where the discharge is released into a water of
the United States. Latitude and longitude coordinates may be
obtained in a variety of ways, including use of hand held devices
(e.g., a GPS enabled smartphone), internet mapping tools (e.g.,
https://mynasadata.larc.nasa.gov/latitudelongitude-finder/),
geographic information systems (e.g., ArcView), or paper maps
from trusted sources (e.g., U.S. Geological Survey or USGS).For
further guidance, refer to
http://www.ePa.gov/geospatia1/1atitudelongitude-data-standard.
Section 2. Line Drawing
Item 2.1. Attach a line drawing showing water flow through your
facility, from intake to discharge. Indicate the sources of intake
water (e.g., city, well, stream, other); operations contributing
wastewater to the effluent including process and production areas,
sanitary flows, cooling water, and stormwater runoff; and treatment
units labeled to correspond to the more detailed descriptions under
Section 3. You may group similar operations into a single unit.
Construct a water balance on the line drawing by showing average
flows (specify units) between intakes, operations, treatment units,
and outfalls. Show all significant losses of water to products, the
atmosphere, and discharge. You should use actual measurements
wherever available; otherwise use your best estimate. If you cannot
determine a water balance for your activities (such as mining
activities), provide a pictorial description of the nature and amount
of any sources of water and any collection and treatment measures.
An example of an acceptable line drawing is provided in Exhibit
2C-1 at the end of these instructions.
Section 3. Average Flows and Treatment
Item 3.1. For each outfall identified under Item 1.1, provide the
following information: (1) all processes, operations, or production
areas that contribute wastewater to the effluent for the outfall,
including process wastewater, sanitary wastewater, cooling water,
and stormwater runoff; (2) average flow of wastewater contributed
by each operation in million gallons per day (mgd); (3) a description
of the treatment unit (including size of each treatment unit, flow rate
through each treatment unit, retention time, etc.); (4) the applicable
treatment code(s) from Exhibit 2C-2 (see end of instructions); and
(5) the ultimate disposal of any solid or fluid wastes that are not
discharged to the receiving water. You may describe processes,
operations, or production areas in general terms (e.g., "dye -making
reactor" or "distillation tower"). You may estimate the average flow
of point sources composed of stormwater; however, you must
2C-1

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

FORM 2C—INSTRUCTIONS CONTINUED
Table
Pollutants/Parameters
Who Completes?
A
Conventional and non-
All applicants from all outfalls unless a
conventional pollutants
waiver is obtained from the NPDES
permitting authority.
B
Toxic metals, cyanide, total
Applicants in the primary industry
phenols, and organic toxic
categories listed in Exhibit 2C-3 at the
pollutants
end of these instructions.
C
Certain conventional and
Applicants subject to ELGs that limit
non -conventional pollutants
pollutants directly or indirectly and
applicants who believe pollutants may
be present in their facility's discharge.
D
Certain hazardous
Applicants who believe pollutants may
substances and asbestos
be present in their facility's discharge.
E
2,3,7,8-tetrachlorodibenzo-
Applicants that use or manufacture the
p-dioxin (2,3,7,8-TCDD)
pollutant or believe the pollutant may
be present in the facility's discharge.
Important note: Read the "General Instructions for Reporting,
Sampling, and Analysis" on pages 2C-5 and 2C-6 before
completing Section 7 and Tables A through E.
Item 7.1 and Table A. All applicants must report at least one
analysis for each conventional and non -conventional pollutant listed
in Table A for each outfall (one table per outfall). This includes
outfalls discharging only noncontact cooling water or stormwater
runoff. However, at your request, the NPDES permitting authority
may waive the requirement to test for one or more of the listed
pollutants for specific outfalls, upon a determination that available
information is adequate to support issuance of your NPDES permit
with less stringent reporting requirements. You may also request a
waiver from your NPDES permitting authority for one or more of the
Table A pollutants for your industry category or subcategory.
Indicate whether you are requesting a waiver in response to Item
7.1. If yes, continue to Item 7.2. If no, skip to Item 7.3.
Item 7.2. Specify the outfalls for which you are requesting a waiver.
Next, indicate on Table A for the applicable outfalls the pollutants
for which the waiver is being requested. Attach your waiver request
and supporting information to your completed Form 2C.
Item 7.3. Test your effluent from each outfall for each pollutant
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
pollutants. See the "General Instructions for Reporting, Sampling,
and Analysis" on pages 2C-5 and 2C-6 for further information.
Item 7.4 and Table B. This item asks whether any of the facility's
processes that contribute wastewater fall into one or more of the
primary industry categories listed in Exhibit 2C-3. If you are
applying for a permit for a privately owned treatment works,
determine your testing requirements based on the industrial
categories of your contributors. This exercise is simply to determine
your testing requirements only. You are not giving up your right to
challenge your inclusion in the category determined for testing (e.g.,
for deciding whether an ELG is applicable) before your permit is
issued. If yes, continue to Item 7.5. If no, skip to Item 7.8.
Complete a separate Table B for each outfall. Section 1 of Table B
lists toxic metals, cyanide, and total phenols. Sections 2 through 5
of Table B list the pollutants in each of the gas
chromatography/mass spectrometry (GC/MS) fractions. Note that
inclusion of total phenols in Section 1 of Table B does not mean
that EPA is classifying the group as toxic pollutants.
Item 7.5. Because you indicated in Item 7.4 that the facility's
processes contribute wastewater that falls into one or more of the
primary industry categories, check "Testing Required" for all toxic
metals, cyanide, and total phenols in Section 1 of Table B. Answer
"Yes" to Item 7.5 once you have completed this task.
Item 7.6. Because you indicated in Item 7.4 that the facility's
processes contribute wastewater that falls into one or more of the
primary industry categories, list the primary industry categories
applicable to your facility. Next, review Exhibit 2C-3 to determine
whether testing is required and for which GC/MS fraction(s): volatile
compounds, acid compounds, base/neutral compounds, and
pesticides. Check the applicable boxes for each GC/MS fraction
requiring testing.
Item 7.7. For each of the required GC/MS fractions, check "Testing
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
have completed this task.
Item 7.8 and Sections 1 through 5 of Table B. For all other cases
(secondary industries, nonprocess wastewater outfalls, and
nonrequired GC/MS fractions) and remaining pollutants, check
"Believed Present" or "Believed Absent" in Sections 1 through 5 of
Table B to indicate whether you have reason to believe that any of
the pollutants listed are discharged from your outfalls. Answer "Yes"
to Item 7.8 after you have completed this step.
Item 7.9 and Section 1 of Table B. For each pollutant you know or
have reason to believe is present in your discharge from each
applicable outfall in concentrations of 10 parts per billion (ppb) or
greater, you must report quantitative data. For every pollutant
expected to be discharged in concentrations less than 10 ppb, you
must submit quantitative data or briefly describe the reasons the
pollutant is expected to be discharged. For pollutants in intake
water, see the discussion under "General Instructions for Reporting,
Sampling, and Analysis" below. Answer "Yes" to Item 7.9 once you
have completed Section 1 of Table B.
Item 7.10. This item asks if you qualify as a "small business." If so,
you are exempt from submitting quantitative data for the organic
toxic pollutants on Table B (Sections 2 through 5). You still must
indicate, though, whether you believe any of the pollutants listed in
Sections 1 through 5 are present in your discharge per the
Instructions at Item 7.8 above.
You can qualify as a small business in two ways: (1) If your facility
is a coal mine and if your probable total annual production is less
than 100,000 tons per year, you may submit past production data
or estimated future production (such as a schedule of estimated
total production under 30 CFR 795.14(c)) instead of conducting
analyses for the organic toxic pollutants. (2) If your facility is not a
coal mine and if your gross total annual sales for the most recent
three years average less than $100,000 per year (in second
quarter 1980 dollars), you may submit sales data for those years
instead of conducting analyses for the organic toxic pollutants.
The production or sales data must be for the facility that is the
source of the discharge. The data should not be limited to
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
goods and services, the transfer price per unit should approximate
market prices for those goods and services as closely as possible.
Sales figures for years after 1980 should be indexed to the second
quarter of 1980 by using the gross national product price deflator
(second quarter of 1980 =100). This index is available online from
the U.S. Department of Commerce, Bureau of Economic Analysis
at http://bea.aov/national/pdf/SNTables.pdf.
If you qualify as a small business according to the criteria above,
answer "Yes" to Item 7.10. Check the box at the top of Table B to
show that you are not required to submit quantitative data for the
organic toxic pollutants (Sections 2 through 5 of Table B), then
skip to Item 7.12. Otherwise, answer "No" and continue to Item
7.11.
Item 7.11 and Sections 2 through 5 of Table B. Unless you
qualify as a small business (see Item 7.10), you must provide
quantitative data for all pollutants for which you marked "Testing
Required" in Sections 2 through 5 of Table B. You must also
provide quantitative data for all pollutants you marked as `Believed
Present' in Sections 2 through 5 of Table B if you discharge those
pollutants in concentrations of 10 ppb or greater, except for
acrolein, acrylonitrile, 2,4-dinitrophenol, and 2-methyl-4,6-
dinitrophenol. If you discharge any of the four latter pollutants in
concentrations of 100 ppb or greater, you must report quantitative
data. If you discharge the pollutants in Sections 2 through 5 of
Table B less than these thresholds (i.e., <100 ppb for acrolein,
acrylonitrile, 2,4-dinitrophenol, and 2-methyl -4,6-dinitrophenol and
<10 ppb for all others), you must submit quantitative data or briefly
describe the reasons the pollutant is in your discharge.
For pollutants in intake water, see the discussion under "General
Instructions for Reporting, Sampling, and Analysis" on pages
2C-5 and 2C-6 for further information.
Once you have completed these tasks, answer "Yes" to Item 7.11.
Item 7.12 and Table C. For each outfall (including outfalls
containing only noncontact cooling water or stormwater runoff),
indicate whether you know or have reason to believe that any of
the pollutants listed on Table C are present in your discharge. If
so, mark the box in the "Believed Present' column for each
applicable pollutant. If not, mark the box in the 'Believed Absent'
column for each applicable pollutant. Answer "Yes" to Item 7.12
once you have completed the required task for each outfall.
Item 7.13 and Table C. You are required to report quantitative
data for any Table C pollutants that are directly limited in an
applicable ELG or are indirectly limited in an applicable ELG
through an expressed limitation on an indicator (e.g., use of total
suspended solids (TSS) as an indicator to control the discharge
of iron and aluminum). For all other pollutants that you marked as
"Believed Present," you must either report quantitative data or
briefly describe the reasons the pollutant is expected to be
discharged.
For pollutants in intake water, see the discussion under "General
Instructions for Reporting, Sampling, and Analysis" on pages
2C-5 and 2C-6 for further information.
Answer "Yes" to Item 7.13 when you have fully completed the
tasks associated with Table C and Items 7.12 and 7.13 above.
Item 7.14 and Table D. For each outfall, indicate if you believe that
any pollutant listed in Table D is "Believed Present' or "Believed
Absent' in your facility's effluent. Check the boxes in the applicable
columns on Table D next to each pollutant. For every pollutant
believed present, you must briefly describe the reasons the
pollutant is expected to be discharged and report any quantitative
data you have for that pollutant. Note that you are not required to
perform analytical tests for any of the Table D pollutants at this time.
However, if you have prior test results, you must report them.
Item 7.15. Answer "Yes" to this Item when you have completed
Table D.
Under 40 CFR 117.12(a)(2), certain discharges of hazardous substances
(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
requirements, civil penalties, and liability for cleanup costs for spills of oil and
hazardous substances. A discharge of a particular substance can be exempted
if the origin, source, and amount of the discharged substances are identified in
the NPDES permit application or in the permit, if the permit contains a
requirement for treatment of the discharge, and if the treatment is in place.
Exemptions are allowed from the requirements of CWA Section 311.
Applications for exemptions must set forth the following information:
1. The substance and the amount of each substance that may be discharged.
The origin and source of the discharge of the substance.
The treatment to be provided for the discharge by:
a. An onsite treatment system separate from any treatment system
treating your normal discharge;
b. A treatment system designed to treat your normal discharge and that is
additionally capable of treating the amount of the substance identified
under paragraph 1 above; or
c. Any combination of the above.
See 40 CFR 117.12(a)(2) and (c) or contact your NPDES permitting authority
for further information on exclusions from CWA Section 311.
Item 7.16. Indicate whether:
• Your facility uses or manufactures 2,4,5-trichlorophenoxy
acetic acid (2,4,5-T); 2-(2,4,5-trichlorophenoxy) propanoic acid
(Silvex, 2,4,5-TP); 2-(2,4,5-trichlorophenoxy) ethyl 2,2-dichloro-
propionate (Erbon); 0,0-dimethyl 0-(2,4,5-trichlorophenyl)
phosphorothioate (Ronnel); 2,4,5,-trichlorophenol (TCP); or
hexachlorophene (HCP).
• You know or have reason to believe that 2.3.7,8-
tetrachlorodibenzo-p-dioxin (TCDD) is or may be present in an
effluent.
If yes, continue to Item 7.17. If no, skip to Section 8.
Item 7.17 and Table E. If you answered "Yes" to Item 7.16, you
must report qualitative data, generated using a screening procedure
not calibrated with analytical standards, for TCDD. Your screening
analyses must be performed using gas chromatography with an
electron capture detector. A TCDD standard for quantitation is not
required. Describe the results of your screening analysis (e.g., "no
measurable baseline deflection at the retention time of TCDD" or "a
measurable peak within the tolerances of the retention time of
TCDD.") on Table E. The NPDES permitting authority may require
you to perform a quantitative analysis if you report a positive result.
Answer "Yes" to Item 7.17 when you have completed Table E.
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
Complete the applicable tables for each outfall at your facility. Be
sure to note the EPA Identification Number, NPDES permit number,
facility name, and applicable outfall number at the top of each page
of the tables and any associated attachments.
You may report some or all of the required data by attaching
separate sheets of paper instead of completing Tables A through E
for each of your outfalls so long as the sheets contain all of the
required information and are similar in format to Tables A through
E. For example, you may be able to print a report in a compatible
format from the data system used in your GC/MS analysis
completed under Table B.
Table A requires you to report at least one analysis for each
pollutant listed. Tables B through D require you to report analytical
data in two ways. For some pollutants, you may be required to
check the box in the "Testing Required" column and test and report
the levels of the pollutants in your discharge whether or not you
expect them to be present in your discharge. For all other
pollutants, you must check the box in either the "Believed Present'
or "Believed Absent' columns based on your best estimate and test
for those you believe to be present (with some exceptions). Base
your determination that a pollutant is present in or absent from your
discharge on your knowledge of your raw materials, maintenance
chemicals, intermediate and final products and byproducts, and any
previous analyses known to you of your effluent or similar effluent.
For example, if you manufacture pesticides, you should expect
those pesticides to be present in contaminated stormwater runoff.
If you would expect a pollutant to be present solely because of its
presence in your intake water, you must mark "Believed Present'
but you are not required to analyze for that pollutant. Instead, mark
an "X" in the long-term average value of the "Intake" column;
optionally, you may instead provide intake data.
Reporting of Effluent Data
Report sampling results for all pollutants in Tables A through C as
concentration and total mass, except for flow, temperature, pH,
color, and fecal coliform organisms. If you are reporting
quantitative data under Table D, report concentration only.
Flow, temperature, pH, color, and fecal coliform organisms must be
reported as mgd, degrees Celsius (°C), standard units, color units,
and most probable number per 100 milliliters (MPN/100 mL),
respectively. Use the following abbreviations in the columns
requiring "units" in Tables A through D.
Concentration
Mass
ppm = parts per million
Ibs = pounds
mg/L = milligrams per liter
ton = tons (English tons)
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)
• An applicable, promulgated ELG specifies the limitation for
the metal in dissolved, valent, or total form;
All approved analytical methods for the metal inherently
measure only its dissolved form (e.g., hexavalent chromium);
or
• The permitting authority has determined that in establishing
case -by -case limitations it is necessary to express the
limitations of the metal in dissolved, valent, or total form to
carry out the provisions of the CWA.
Note that you are not required to complete the "Maximum Monthly
Discharge" and the "Long -Term Average Daily Discharge" columns
of Tables A through C; however, these fields should be completed
if data are available.
If you measure only one daily value, complete the "Maximum Daily
Discharge" columns of the tables and enter 1" in the "Number of
Analyses" columns. The NPDES permitting authority may require
additional analyses to further characterize your discharges.
For composite samples, the daily value is the total mass or
average concentration found in a composite sample taken over the
operating hours of the facility during a 24-hour period. For grab
samples, the daily value is the arithmetic or flow -weighted total
mass or average concentration found in a series of at least four
grab samples taken over the operating hours of the facility during a
24-hour period.
If you measure more than one daily value for a pollutant and those
values are representative of your wastestream, you must report
them. You must describe your method of testing and data analysis.
When an applicant has two or more outfalls with substantially
identical effluents, the NPDES permitting authority may allow the
applicant to test only one outfall and report those quantitative data
as applying to the substantially identical outfall. If the permitting
authority grants your request, attach a separate sheet to the
application form identifying the outfall tested and describing why the
other outfall(s) are substantially identical.
Reporting of Intake Data
You are not required to report data under the "Intake" columns of
Tables A through C unless you wish to demonstrate your eligibility
for a "net' effluent limitation for one or more pollutants in Tables A
through C (i.e., an effluent limitation adjusted by subtracting the
average level of the pollutant(s) present in your intake water).
NPDES regulations allow net limitations only in certain
circumstances. To demonstrate your eligibility, under the "Intake"
columns report the average of the results of analyses of your intake
water and discuss the requirements for a net limitation with your
NPDES permitting authority. If your water is treated before use, test
the water after it has been treated.
2C-5

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

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

Exhibit 2C-1. Example Line Drawing
Blue River Municipal
90,D00 GP❑ Water Supply Blue River
10,000 GP❑
fD 45,DOO GPD 30,000 GP❑ Cooling Water
Raw MaterialsFiber ODD 20,D06 70 ODO S,ODD GPD
Dyeing Washing Drying
t0,OD0 GPDPD GPD Gp❑ To Atmospl
D 40,000 GPD 40,000 10,000 To Product
GPD GPD 5,000 GP❑
Solid WasteNeutralization Loss Waste Tank g 00D GP❑ Treatment
4,ODO GPD Plant 42
36,000 GPD 34,DD0 GPD Outtall D02
50,000 GP❑
Waste OutFa1' 001
Stormwater Treatment 70,000 GPD +Storm r
Max: 20.000 GPD 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)
2-13
................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
5-13
................Anaerobic digestion
5—N ................Heat
treatment
5—C
................ Belt filtration
5-0 ................Incineration
5—D
................ Centrifugation
5—P .................
Land application
5—E
................ Chemical conditioning
5-0 ................
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
5-1.1 ................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
Adhesives and sealants........................................................
Aluminumforming.................................................................
Auto and other laundries.......................................................
Battery manufacturing...........................................................
Coalmining...........................................................................
Coilcoating...........................................................................
Copperforming.....................................................................
Electric and electronic compounds .......................................
Electroplating........................................................................
Explosives manufacturing.....................................................
Foundries..............................................................................
Gum and wood chemicals (all subparts except D and F) .....
Gum and wood chemicals, Subpart D (tall oil rosin) .............
Gum and wood chemicals, Subpart F (rosin -based
derivatives)...........................................................................
Inorganic chemicals manufacturing ......................................
Iron and steel manufacturing ................................................
Leather tanning and finishing
Mechanical products manufacturing .....................................
Nonferrous metals manufacturing .........................................
Ore mining, Subpart B (base and precious metals) ..............
Organic chemicals manufacturing ........................................
Paint and ink formulation......................................................
Pesticides.............................................................................
Petroleumrefining.................................................................
Pharmaceutical preparations ................................................
Photographic equipment and supplies ..................................
Plastic and synthetic materials manufacturing ......................
Plastic processing.................................................................
Printing and publishing.........................................................
Pulp and paperboard mills ....................................................
Rubber processing................................................................
Soap and detergent manufacturing ......................................
Steam electric power plants ..................................................
Textile mills (except Subpart C, Greige Mills) .......................
Timber products processing .................................................
GC/MS FRACTIONt
Volatile
Acid
Base/Neutral
Pesticide
X
X
X
X
X
X
X
X
X
X
X
❑
X
❑
❑
-1
❑
X
X
X
❑
X
X
X
❑
X
X
X
X
X
X
X
❑
❑
X
X
❑
X
X
X
❑
X
X
❑
❑
X
X
X
❑
X
X
X
❑
X
X
X
❑
X
X
X
❑
X
X
X
❑
X
X
X
❑
X
X
X
X
X
-1
❑
X
X
X
X
X
X
X
❑
X
X
X
X
X
II
❑
❑
X
X
X
❑
X
X
X
❑
X
X
X
X
X
❑
-1
❑
X
X
X
X
X
X
X
X
X
X
X
❑
X
X
X
❑
X
X
❑
❑
X
X
X
❑
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.
t The pollutants in each fraction are listed in Table B.
X = Testing is required.
= Testing is not required.
2C-10

1. Acetaldehyde
2. Acetic acid
3. Acetic anhydride
4. Acetone cyanohydrin
5. Acetyl bromide
6. Acetyl chloride
7. Acrolein
8. Acrylonitrile
9. Adipic acid
10. Aldrin
11. Allyl alcohol
12. Allyl chloride
13. Aluminum sulfate
14. Ammonia
15. Ammonium acetate
16. Ammonium benzoate
17. Ammonium bicarbonate
18. Ammonium bichromate
19. Ammonium bifluoride
20. Ammonium bisulfite
21. Ammonium carbamate
22. Ammonium carbonate
23. Ammonium chloride
24. Ammonium chromate
25. Ammonium citrate
26. Ammonium fluoroborate
27. Ammonium fluoride
28. Ammonium hydroxide
29. Ammonium oxalate
30. Ammonium silicofluoride
31. Ammonium sulfamate
32. Ammonium sulfide
33. Ammonium sulfite
34. Ammonium tartrate
35. Ammonium thiocyanate
36. Ammonium thiosulfate
37. Amyl acetate
38. Aniline
39. Antimony pentachloricle
40. Antimony potassium tartrate
41. Antimony tribromide
42. Antimony trichloride
43. Antimony trifluoride
44. Antimony trioxide
45. Arsenic disulfide
46. Arsenic pentoxide
47. Arsenic trichloride
48. Arsenic trioxide
49. Arsenic tisulfide
50. Barium cyanide
51. Benzene
52. Benzoic acid
53. Benzonitrile
54. Benzoyl chloride
55. Benzyl chloride
56. Beryllium chloride
57. Beryllium fluoride
58. Beryllium nitrate
59. Butylacetate
60. n-butylphthalate
61. Butylamine
62. Butyric acid
63. Cadmium acetate
64. Cadmium bromide
65. Cadmium chloride
66. Calcium arsenate
67. Calcium arsenite
68. Calcium carbide
69. Calcium chromate
70. Calcium cyanide
71. Calcium dodecylbenzenesulfonate
72. Calcium hypochlorite
Exhibit 2C-4. Hazardous Substances
73. Captan
74. Carbaryl
75. Carbofuran
76. Carbon disulfide
77. Carbon tetrachloride
78. Chlordane
79. Chlorine
80. Chlorobenzene
81. Chloroform
82. Chloropyrifos
83. Chlorosulfonic acid
84. Chromic acetate
85. Chromic acid
86. Chromic sulfate
87. Chromous chloride
88. Cobaltous bromide
89. Cobaltous formate
90. Cobaltous sulfamate
91. Coumaphos
92. Cresol
93. Crotonaldehyde
94. Cupric acetate
95. Cupric acetoarsenite
96. Cupric chloride
97. Cupric nitrate
98. Cupric oxalate
99. Cupric sulfate
100. Cupric sulfate ammoniated
101. Cupric tartrate
102. Cyanogen chloride
103. Cyclohexane
104.2,4-D acid (2,4-dichlorophenoxyacetic acid)
105. 2,4-D esters (2,4-dichlorophenoxyacetic acid esters)
106. DDT
107. Diazinon
108. Dicamba
109. Dichlobenil
110. Dich lone
111. Dichlorobenzene
112. Dichloropropane
113. Dichloropropene
114. Dichloropropene-dichloproropane mix
115.2,2-dichloropropionic acid
116. Dichlorvos
117. Dieldrin
118. Diethylamine
119. Dimethylamine
120. Dinitrobenzene
121. Dinitrophenol
122. Dinitrotoluene
123. Diquat
124. Disulfoton
125. Diuron
126. Dodecylbenzesulfonic acid
127. Endosulfan
128. Endrin
129. Epichlorohydrin
130. Ethion
131. Ethylbenzene
132. Ethylenediamine
133. Ethylene dibromide
134. Ethylene dichloride
135. Ethylene diaminetetracetic acid (EDTA)
136. Ferric ammonium citrate
137. Ferric ammonium oxalate
138. Ferric chloride
139. Ferric fluoride
140. Ferric nitrate
141. Ferric sulfate
142. Ferrous ammonium sulfate
143. Ferrous chloride
144. Ferrous sulfate
145. Formaldehyde
146. Formic acid
147. Fumaric acid
148. Furfural
149. Guthion
150. Heptachlor
151. Hexachlorocyclopentadiene
152. Hydrochloric acid
153. Hydrofluoric acid
154. Hydrogen cyanide
155. Hydrogen sulfide
156. Isoprene
157. Isopropanolamine dodecylbenzenesulfonate
158. Kelthane
159. Kepone
160. Lead acetate
161. Lead arsenate
162. Lead chloride
163. Lead fluoborate
164. Lead fluorite
165. Lead iodide
166. Lead nitrate
167. Lead stearate
168. Lead sulfate
169. Lead sulfide
170. Lead thiocyanate
171. Lindane
172. Lithium chromate
173. Malathion
174. Maleic acid
175. Maleic anhydride
176. Mercaptodimethur
177. Mercuric cyanide
178. Mercuric nitrate
179. Mercuric sulfate
180. Mercuric thiocyanate
181. Mercurous nitrate
182. Methoxychlor
183. Methyl mercaptan
184. Methyl methacrylate
185. Methyl parathion
186. Mevinphos
187. Mexacarbate
188. Monoethylamine
189. Monomethylamine
190. Naled
191. Naphthalene
192. Naphthenic acid
193. Nickel ammonium sulfate
194. Nickel chloride
195. Nickel hydroxide
196. Nickel nitrate
197. Nickel sulfate
198. Nitric acid
199. Nitrobenzene
200. Nitrogen dioxide
201. Nitrophenol
202. Nitrotoluene
203. Paraformaldehyde
204. Parathion
205. Pentachlorophenol
206. Phenol
207. Phosgene
208. Phosphoric acid
209. Phosphorus
210. Phosphorus oxychloride
211. Phosphorus pentasulfide
212. Phosphorus trichloride
213. Polychlorinated biphenyls (PCB)
214. Potassium arsenate
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 acid
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-tdchlorophenoxyacetic 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 bisulfate
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

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NCO088714 NCO088714 Lassiter Farms Community Well OMB No. 2040-0004
n,Tn
Form U.S. Environmental Protection Agency
2C d"A. EPl1 Application for NPDES Permit to Discharge Wastewater
NPDES EXISTING MANUFACTURING, COMMERCIAL, MINING, AND SILVICULTURE OPERATIONS
SECTIONOUTFALL LOCATIONi
1.1 Provide information on each of the facility's outfalls in the table below.
Outfa
Nu ber Receiving Water Name Latitude Longitude
001 unnamed tributary to Ditch 35° 36' 28 N 78' 38' 21' W
O
SECTIONo
D' I
Im 2.1 Have you attached a line drawing to this application that shows the water flow through your facility with a water
3 balance? (See instructions for drawing requirements. See Exhibit 2C-1 at end of instructions for example.)
J `
o ❑✓ Yes ❑ No
SECTION• i
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
Operation Average Flow
mgd
r
c
E mgd
r
a�
mgd
y mgd
3
0 Treatment Units
U-
a, 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
EPA Form 3510-2C (Revised 3-19) Page 1

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
NCO088714
NCO088714
Lassiter Farms Community Well
\A=
OMB No. 2040-0004
3.1
**Outfall Number**
Cont.
Operations,
Operation
Average Flow
mgd
mgd
mgd
mgd
Treatment
Description
Units
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
as
c
0
U
c
m
E
is
a>
H
**Outfall Number**
y
Operations
o
Operation
Average Flow
U-
a,
mgd
L
a'
mgd
mgd
mgd
Treatment
Description
Units
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.
cn M
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
NCO088714 NCO088714 Lassiter Farms Community Well OMB No. 2040-0004
�niTn
SECTION • I
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 In cessar .
Outfall
Operation
Frequency
Flow
Rate
Average
Average
Long -Term
Maximum
Number
(list)
Duration
Da sMeek
Months/Year
Average
Dail
Backwash Discharge
1 days/week
months/year
1702 mgd
3420 mgd
0 days
c001
days/week
months/year
mgd
mgd
days
UL
days/week
months/year
mgd
mgd
days
w
E
days/week
months/year
mgd
mgd
days
w
c
days/week
months/year
mgd
mgd
days
days/week
months/year
mgd
mgd
days
days/week
months/year
mgd
mgd
days
days/week
months/year
mgd
mgd
days
days/week months/year mgd mgd days
SECTION'-•1
• I
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.
5.2
Provide the following information on applicable ELGs.
ELG Category
ELG Subcategory
Regulatory Citation
w
a�
cc
R
Q
n
a
5.3
Are any of the applicable ELGs expressed in terms of production (or other measure of operation)?
❑ Yes ❑✓ No 4 SKIP to Section 6.
0
;g
5.4
Provide an actual measure of daily production expressed in terms and units of applicable ELGs.
J
Outfall
Operation, Product, or Material
Quantity per Day
Unit of
Number
Measure
d
cc
m
0
r
c�
0
L
a
EPA Form 3510-2C (Revised 3-19) Page 3

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NCO088714 NCO088714 Lassiter Farms Community Well OMB No. 2040-0004
niTn
SECTION • IMPROVEMENTS (40
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
oProject
(list outfall
Discharge
Required
Projected
CL
number
E
-
ca
ca
CM
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
SECTIONI
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?
0 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 001 Outfall Number Outfall Number
7.3
Have you completed monitoring for all Table A pollutants at each of your outfalls for which a waiver has not been
y
requested and attached the results to this application package?
L
No; a waiver has been requested from my NPDES
❑✓ Yes ❑
permitting authority for all pollutants at all outfalls.
Table B.
Toxic Metals, Cyanide, Total Phenols, and Organic Toxic Pollutants
7.4
Do any of the facility's processes that contribute wastewater fall into one or more of the primary industry categories
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?
LU
❑ 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 ❑ Acid ❑ Base/Neutral ❑ Pesticide
❑ Volatile ❑ Acid ❑ Base/Neutral ❑ Pesticide
❑ Volatile ❑ Acid ❑ Base/Neutral ❑ Pesticide
EPA Form 3510-2C (Revised 3-19) Page 4

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
NCOO88714
NCOO88714
Lassiter Farms Community Well
Alin
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 4 Note that you qualify at the top of Table B, ❑ No
then SKIP to Item 7.12.
7.11
Have you provided (1) quantitative data for those Sections 2 through 5, Table B, pollutants for which you have
c
determined testing is required or (2) quantitative data or an explanation for those Sections 2 through 5, Table B,
y
pollutants you have indicated are "Believed Present' in your discharge?
`—'
❑ 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?
Y
❑✓ Yes ❑ No
7.13
Have you completed Table C by providing (1) quantitative data for those pollutants that are limited either directly or
indirectly in an ELG and/or (2) quantitative data or an explanation for those pollutants for which you have indicated
"Believed Present"?
❑ Yes ❑ No
LU
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- -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 i
8.1
Is any pollutant listed in Table B a substance or a component of a substance used or manufactured at your facility as
an intermediate or final product or byproduct?
3
❑ Yes ❑✓ No 4 SKIP to Section 9.
3
8.2
List the pollutants below.
a —
1. 4. 7.
0
2. 5. 8.
N
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
NCO088714 NCO088714 Lassiter Farms Community Well OMB No. 2040-0004
niTn
SECTION • BIOLOGICAL TOXICITYI
9.1 Do you have any knowledge or reason to believe that any biological test for acute or chronic toxicity has been made
within the last three years on (1) any of your discharges or (2) on a receiving water in relation to your discharge?
�, ❑ Yes ❑✓ No 4 SKIP to Section 10.
r
tp
9.2
Identify the tests and their
purposes below.
.5
Test(s)
Purpose of Test(s)
Submitted to NPDES
Date Submitted
x
Permitting Authority?
0
H
ElYes ElNo
M
0
m0
❑ Yes ❑ No
❑ Yes ❑ No
SECTIONI
CONTRACT
ANALYSES (40
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
ENCO Labs
Vl
d
Z,
Laboratory address
102-A Woodwinds Industrial
QCourt
Cary INC, 27511
r
c�
R
L
Phone number
[phone]
Pollutant(s) analyzed Total Suspended Sollids
SECTIONDD
• •- • I
11.1
Has the NPDES permitting authority requested additional information?
❑ Yes ❑✓ No SKIP to Section 12.
0
L
11.2
List the information requested and attach it to this application.
O
1. 4.
0
2. 5.
>3
3. 6.
EPA Form 3510-2C (Revised 3-19) Page 6

EPA Identification Number
NPDES Permit Number Facility Name Form Approved 03/05/19
NCO088714
NCO088714 Lassiter Farms Community Well OMB No. 2040-0004
niTn
SECTION 12. CHECKLIST AND CERTIFICATION STATEMENT I
12.1
In Column 1 below, mark the sections of Form 2C that you have completed and are submitting with your application.
For each section, specify in Column 2 any attachments that you are enclosing to alert the permitting authority. Note
that not all applicants are required to complete all sections or provide attachments.
Column 1
Column 2
© Section 1: Outfall Location
❑✓ w/ attachments
❑✓ Section 2: Line Drawing
✓❑ w/ line drawing ❑ w/ additional attachments
Section 3: Average Flows and
0
w/ list of each user of
❑ w/ attachments ❑ privately owned treatment
Treatment
works
❑ Section 4: Intermittent Flows
❑ wl attachments
❑ Section 5: Production
❑ wl attachments
w/ optional additional
❑ Section 6: Improvements
❑ wl attachments ❑ sheets describing any
additional pollution control
plans
w/ request for a waiver and ❑ w/ explanation for identical
supporting information outfalls
d
wl small business exemption wl other attachments
El ❑
4
in
Section 7: Effluent and Intake
0 w/ Table A ❑✓ w/ Table B
Characteristics
© wl Table C ❑✓ w/ Table D
w
❑✓ wl Table E ❑ w/ analytical results as an
c�
attachment
❑ Section 8: Used or Manufactured
❑ w/ attachments
Toxics
❑ Section 9: Biological Toxicity
❑ w/ attachments
Tests
c.�
❑ Section 10: Contract Analyses
❑ w/ attachments
❑ Section 11: Additional Information
❑ w/ attachments
Section 12: Checklist and
❑ w/ attachments
Certification Statement
12.2
Certification Statement
l certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly
responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. / am aware that there are significant penalties for submitting false information, including the
possibility of fine and imprisonment for knowing violations.
Name (print or type first and last name)
Official title
Amanda Berger
Environmental Compliance Director
Signature
Date signed
10/14/2022
EPA Form 3510-2C (Revised 3-19) Page 7

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
NCO08E NCO088714 Lassiter Farms Community Well
%A/TD
Form Approved 03/05/19
OMB No. 2040-0004
Effluent
Intake
Waiver
o tional
Maximum
Maximum
Long -Term
Pollutant
Requested
Units
(specify)
Daily
Monthly
Average Daily
Number of
Long -Term
Number of
(if applicable)
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
IZI
Concentration
Mass
(BOD5)
2'
Chemical oxygen demand
IZI
Concentration
Mass
(COD)
Concentration
3.
Total organic carbon (TOC)
✓❑
Mass
Concentration
4.
Total suspended solids (TSS)
✓❑
Mass
Concentration
5.
Ammonia (as N)
✓❑
Mass
6.
Flow
❑
Rate
gpd
3420
1702
262
Temperature (winter)
❑✓
°C
°C
7.
Temperature (summer)
✓❑
°C
°C
pH (minimum)
❑
Standard units
S.U.
6.4
7.2
268
8.
pH (maximum)
❑
Standard units
SM.
8.8
7.2
268
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C (Revised 3-19) Page 9

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NCO08E NCO088714 Lassiter Farms Community Well 001 OMB No. 2040-0004
Presence or Absence
Intake
check one
Effluent
(optional)
Pollutant/Parameter
Testing
Units
Maximum
Maximum
Long -Term
Long -
(and CAS Number, if available)
Required
Believed
Believed
(specify)
Daily
thl
Mony
Average
Number
Term
Number
Present
Absent
Discharge
Discharge
Daily
of
Average
of
(required)
( available)
Discharge
Analyses
Analyses
if available
El Check here if you qualify as a small business per the instructions to Form 2C and, therefore, do not need to submit quantitative data for any of the organic toxic pollutants in Sections
2 through 5 of this table. Note, however, that you must still indicate in the appropriate column of this table if you believe any of the pollutants listed are present in your discharge.
Section 1. Toxic Metals, Cyanide, and Total Phenols
1.1
Antimony, total
✓
Concentration
Mass
(7440-36-0)
1.2
Arsenic, total
✓
Concentration
Mass
(7440-38-2)
1.3
Beryllium, total
Concentration
Mass
(7440-41-7)
1.4
Cadmium, total
El
Concentration
Concentration
(7440-43-9)
1.5
Chromium, total
Concentration
Mass
(7440-47-3)
1.6
Copper, total
El
El
z
Concentration
Mass
(7440-50-8)
1.7
Lead, total
✓
Concentration
Mass
(7439-92-1)
1.8
Mercury, total
©
Concentration
Mass
(7439-97-6)
1.9
Nickel, total
Concentration
Mass
(7440-02-0)
1.10
Selenium, total
Concentration
Mass
(7782-49-2)
1.11
Silver, total
Concentration
Mass
(7440-22-4)
EPA Form 3510-2C (Revised 3-19) Page 11

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NCO08E NCO088714 Lassiter Farms Community Well 001 OMB No. 2040-0004
Presence or Absence
Intake
check one
Effluent
(optional)
Pollutant/Parameter
Testing
Units
Maximum
Maximum
Long -Term
Long -
(and CAS Number, if available)
Required
Believed
Believed
(specify)
Daily
thl
Mony
Average
Number
Term
Number
Present
Absent
Discharge
Discharge
Daily
of
Average
of
(required)
(if available)
Discharge
Analyses
Value
Analyses
if available
1.12
Thallium, total
Concentration
Mass
(7440-28-0)
1.13
Zinc total
✓
Concentration
Mass
(7440-66-6)
1.14
Cyanide, total
El
❑
❑✓
Concentration
Mass
(57-12-5)
1.15
Phenols, total
❑
❑
❑✓
Concentration
Mass
Section 2.Organic Toxic Pollutants (GC/MS Fraction
—Volatile Compounds)
2.1
Acrolein
Concentration
Mass
(107-02-8)
2.2
Acrylonitrile
Concentration
Mass
(107-13-1)
2.3
Benzene
❑
❑
❑
Concentration
Mass
(71-43-2)
2.4
Bromoform
❑
❑
❑✓
Concentration
Mass
(75-25-2)
2.5
Carbon tetrachloride
❑
❑
❑✓
Concentration
Mass
(56-23-5)
2.6
Chlorobenzene
Concentration
Mass
(108-90-7)
2.7
Chlorodibromomethane
❑
❑
❑
Concentration
Mass
(124-48-1)
2.8
Chloroethane
❑
❑
❑
Concentration
Mass
(75-00-3)
EPA Form 3510-2C (Revised 3-19) Page 12

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NCO08E NCO088714 Lassiter Farms Community Well 001 OMB No. 2040-0004
Presence or Absence
Intake
check one
Effluent
(optional)
Pollutant/Parameter
Testing
Units
Maximum
Maximum
Long -Term
Long -
(and CAS Number, if available)
Required
Believed
Believed
(specify)
Daily
Mony
thl
Average
Number
Term
Number
Present
Absent
Discharge
Discharge
Daily
of
Average
of
(required)
(if available)
Discharge
Analyses
Value
Analyses
if available
2'9
2-chloroethylvinyl ether
Concentration
Mass
(110-75-8)
2.10
Chloroform (67-66-3)
©
Concentration
Mass
2.11
Dichlorobromomethane
0
Concentration
Mass
(75-27-4)
212
1,1-dichloroethane
1:1
El
✓
Concentration
Mass
(75-34-3)
2.13
12-dichloroethane
Concentration
Mass
(107-06-2)
2.14
11-dichloroethylene
Concentration
Mass
(75-354)
2.15
1,2-dichloropropane
Concentration
Mass
(78-87-5)
2.16
1,3-dichloropropylene
0
Concentration
Mass
(542-75-6)
2.17
Ethylbenzene
0
Concentration
Mass
(100-41-4)
2.18
Methyl bromide
✓
Concentration
Mass
(74-83-9)
2.19
Methyl chloride
Concentration
Mass
(74-87-3)
2.20
Methylene chloride
Concentration
Mass
(75-09-2)
2.21
1 1,2 2- tetrachloroethane
El
El
0
Concentration
Mass
(79-34-5)
EPA Form 3510-2C (Revised 3-19) Page 13

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NCO08E NCO088714 Lassiter Farms Community Well 001 OMB No. 2040-0004
Presence or Absence
Intake
check one
Effluent
(optional)
Pollutant/Parameter
Testing
Units
Maximum
Maximum
Long -Term
Long -
(and CAS Number, if available)
Required
Believed
Believed
(specify)
Daily
Monthly
Average
Number
Term
Number
Present
Absent
Discharge
Discharge
Daily
of
Average
of
(required)
(if available)
Discharge
g
Analyses
Value
Analyses
f available
2.22
Tetrachloroethylene
❑
❑
❑
Concentration
Mass
(127-18-4)
2.23
Toluene
❑
❑
❑
Concentration
Mass
(108-88-3)
2.24
1,2-trans-dichloroethylene
El
❑
❑✓
Concentration
Mass
(156-60-5)
2.25
1,1,1-trichloroethane
❑
El
❑
Concentration
Mass
(71-55-6)
2.26
1,1,2-trichloroethane
❑
El
❑
Concentration
Mass
(79-00-5)
2.27
Trichloroethylene
❑
❑
©
Concentration
Mass
(79-01-6)
2.28
Vinyl chloride
❑
❑
❑
Concentration
Mass
(75-01-4)
Section 3.Organic Toxic Pollutants (GCIMS Fraction
—Acid Compounds)
3.1
2-chlorophenol
El
El
✓
Concentration
Mass
(95-57-8)
3.2
2 4-dichlorophenol
✓
Concentration
Mass
(120-83-2)
3.3
2 4-dimethyl phenol
✓
Concentration
Mass
(105-67-9)
3.4
4 6-dinitro-o-cresol
El
IZI
Concentration
Mass
(534-52-1)
3.5
2 4-dinitrophenol
❑
❑
❑
Concentration
Mass
(51-28-5)
EPA Form 3510-2C (Revised 3-19) Page 14

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NCO08E NCO088714 Lassiter Farms Community Well 001 OMB No. 2040-0004
Presence or Absence
Intake
check one
Effluent
(optional)
Pollutant/Parameter
Testing
Units
Maximum
Maximum
Long -Term
Long -
(and CAS Number, if available)
Required
Believed
Believed
(specify)
Daily
thl
Mony
Average
Number
Term
Number
Present
Absent
Discharge
Discharge
Daily
of
Average
of
(required)
(if available)
Discharge
Analyses
Value
Analyses
if available
3.6
2-nitrophenol
❑
❑
❑
Concentration
Mass
(88-75-5)
3.7
4-nitrophenol
✓
Concentration
Mass
(100-02-7)
3.8
p-chloro-m-cresol
❑
❑
✓❑
Concentration
Mass
(59-50-7)
3 9
Pentachlorophenol
1:1
El
✓
Concentration
Mass
(87-86-5)
3.10
Phenol
Concentration
Mass
(108-95-2)
3.11
2 4,6-trichlorophenol
❑
❑
❑
Concentration
Mass
(88-05-2)
Section 4.Organic Toxic Pollutants (GCIMS Fraction
—Base /Neutral
Compounds)
4.1
Acenaphthene
❑
❑
❑
Concentration
Mass
(83-32-9)
4.2
Acenaphthylene
Concentration
Mass
(208-96-8)
4.3
Anthracene
✓
Concentration
Mass
(120-12-7)
4.4
Benzidine
©
Concentration
Mass
(92-87-5)
4.5
Benzo (a) anthracene
❑
❑
❑
Concentration
Mass
(56-55-3)
4.6
Benzo (a) pyrene
❑
❑
❑
Concentration
Mass
(50-32-8)
EPA Form 3510-2C (Revised 3-19) Page 15

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
NCO08E NCO088714 Lassiter Farms Community Well 001
Form Approved 03/05/19
OMB No. 2040-0004
Presence or Absence
Intake
check one
Effluent
(optional)
Pollutant/Parameter
Testing
Units
Maximum
Maximum
Long -Term
Long -
(and CAS Number, if available)
Required
Believed
Believed
(specify)
Daily
Mony
thl
Average
Number
Term
Number
Present
Absent
Discharge
Discharge
Daily
of
Average
of
(required)
(if available)
Discharge
Analyses
Value
Analyses
if available
4.7
3 4-benzofluoranthene
Concentration
Mass
(205-99-2)
4.8
Benzo (ghi) perylene
✓
Concentration
Mass
(191-24-2)
4.9
Benzo (k) fluoranthene
✓
Concentration
Mass
(207-08-9)
4.10
Bis (2-chloroethoxy) methane
❑
❑
❑
Concentration
Mass
(111-91-1)
4.11
Bis (2-chloroethyl) ether
❑
❑
©
Concentration
Mass
(111-44-4)
4.12
Bis (2-chloroisopropyl) ether
❑
❑
❑
Concentration
Mass
(102-80-1)
4.13
Bis (2-ethylhexyl) phthalate
❑
❑
❑
Concentration
Mass
(117-81-7)
4.14
4-bromophenyl phenyl ether
❑
❑
❑✓
Concentration
Mass
(101-55-3)
4.15
Butyl benzyl phthalate
❑
❑
❑✓
Concentration
Mass
(85-68-7)
4.16
2-chloronaphthalene
❑
❑
❑
Concentration
Mass
(91-58-7)
4.17
4-chlorophenyl phenyl ether
Concentration
Mass
(7005-72-3)
4.18
Chrysene
❑
❑
❑
Concentration
Mass
(218-01-9)
4.19
Dibenzo (a,h) anthracene
El
El
❑
Concentration
Mass
(53-70-3)
EPA Form 3510-2C (Revised 3-19) Page 16

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
NCO08E NCO088714 Lassiter Farms Community Well 001
Form Approved 03/05/19
OMB No. 2040-0004
Presence or Absence
Intake
check one
Effluent
(optional)
Pollutant/Parameter
Testing
Units
Maximum
Maximum
Long -Term
Long -
(and CAS Number, if available)
Required
Believed
Believed
(specify)
Daily
Mony
thl
Average
Number
Term
Number
Present
Absent
Discharge
Discharge
Daily
of
Average
of
(required)
(if available)
Discharge
Analyses
Value
Analyses
if available
4.20
12-dichlorobenzene
❑
❑
❑
Concentration
Mass
(95-50-1)
4.21
1,3-dichlorobenzene
El
❑
Concentration
Mass
(541-73-1)
4.22
1,4-dichlorobenzene
El
❑
✓❑
Concentration
Mass
(106-46-7)
4.23
3 3-dichlorobenzidine
❑
❑
❑
Concentration
Mass
(91-94-1)
4.24
Diethyl phthalate
❑
❑
❑
Concentration
Mass
(84-66-2)
4.25
Dimethyl phthalate
❑
❑
❑
Concentration
Mass
(131-11-3)
4.26
Di-n-butyl phthalate
❑
❑
❑
Concentration
Mass
(84-74-2)
4.27
2,4-dinitrotoluene
El
❑
❑✓
Concentration
Mass
(121-14-2)
4.28
2,6-dinitrotoluene
El
❑
❑✓
Concentration
Mass
(606-20-2)
4.29
Di-n-octyl phthalate
❑
❑
❑
Concentration
Mass
(117-84-0)
4.30
1,2-Diphenylhydrazine
©
Concentration
Mass
(as azobenzene) (122-66-7)
4.31
Fluoranthene
❑
❑
©
Concentration
Mass
(206-44-0)
4.32
Fluorene
❑
❑
❑
Concentration
Mass
(86-73-7)
EPA Form 3510-2C (Revised 3-19) Page 17

EPA Identification Number NPDES Permit Number Facility Name Cutfall Number Form Approved 03/05/19
NCO08E NCO088714 Lassiter Farms Community Well 001 OMB No. 2040-0004
• 1
•
• 1 •'
• '• I
Presence or Absence
Intake
check one
Effluent
(optional)
Pollutant/Parameter
Testing
Units
Maximum
Maximum
Long -Term
Long -
(and CAS Number, if available)
Required
Believed
Believed
(specify)
Daily
Monthly
Average
Number
Term
Number
Present
Absent
Discharge
Discharge
Daily
of
Average
of
(required)
(if available)
Discharge
g
Analyses
Value
Analyses
f available
4.33
Hexachlorobenzene
❑
❑
❑
Concentration
Mass
(118-74-1)
4.34
Hexachlorobutadiene
❑
❑
❑✓
Concentration
Mass
(87-68-3)
4.35
Hexachlorocyclopentadiene
❑
❑
❑✓
Concentration
Mass
(77-47-4)
4.36
Hexachloroethane
❑
❑
❑
Concentration
Mass
(67-72-1)
4.37
Indeno (1,2,3-cd) pyrene
❑
El
❑
Concentration
Mass
(193-39-5)
4.38
Isophorone
❑
❑
❑
Concentration
Mass
(78-59-1)
4.39
Naphthalene
❑
❑
❑
Concentration
Mass
(91-20-3)
4.40
Nitrobenzene
❑
❑
❑✓
Concentration
Mass
(98-95-3)
4.41
N-nitrosodimethylamine
❑
❑
❑✓
Concentration
Mass
(62-75-9)
4.42
N-nitrosodi-n-propylamine
❑
❑
❑
Concentration
Mass
(621-64-7)
4.43
N-nitrosodiphenylamine
Concentration
Mass
(86-30-6)
4.44
Phenanthrene
❑
❑
❑
Concentration
Mass
(85-01-8)
4.45
Pyrene
El
El
IZI
Concentration
Mass
(129-00-0)
EPA Form 3510-2C (Revised 3-19) Page 18

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
NC008E NC0088714 Lassiter Farms Community Well 001
Form Approved 03/05/19
OMB No. 2040-0004
Presence or Absence
Intake
check one
Effluent
(optional)
Pollutant/Parameter
Testing
Units
Maximum
Maximum
Long -Term
Long -
(and CAS Number, if available)
1
Required
Believed
Believed
(specify)
Daily
thl
Mony
Average
Number
Term
Number
Present
Absent
Discharge
Discharge
Daily
of
Average
of
(required)
(if available)
Discharge
Analyses
Value
Analyses
if available
4.46 1 2 4-trichlorobenzene
El
❑
✓❑
Concentration
Mass
(120-82-1)
Section 5.Organic Toxic Pollutants (GCIMS Fraction
—Pesticides)
5.1
Aldrin
❑
❑
❑
Concentration
Mass
(309-00-2)
5.2
a-BHC
El
❑
IZI
Concentration
Mass
(319-84-6)
5.3
R-BHC
El
❑
❑
Concentration
Mass
(319-85-7)
5.4
y-BHC
❑
El
©
Concentration
Mass
(58-89-9)
5.5
b-BHC
El
IZI
Concentration
Mass
(319-86-8)
5.6
Chlordane
❑
Concentration
Mass
(57-74-9)
5.7
4 4'-DDT
❑
❑
❑
Concentration
Mass
(50-29-3)
5.8
4 4'-DDE
❑
❑
0
Concentration
Mass
(72-55-9)
5.9
4,4'-DDD
El
❑
❑
Concentration
Mass
(72-54-8)
5.10
Dieldrin
❑
❑
❑
Concentration
Mass
(60-57-1)
5.11
a-endosulfan
❑
❑
❑
Concentration
Mass
(115-29-7)
EPA Form 3510-2C (Revised 3-19) Page 19

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
NCO08E NCO088714 Lassiter Farms Community Well 001
Form Approved 03/05/19
OMB No. 2040-0004
• 1
Pollutant/Parameter
(and CAS Number, if available)
•
Testing
Required
• 1 •'
Presence or Absence
(check one)
• '• I Rik CILINI
Units
(specify)
Effluent
Intake
(optional)
Believed
Present
Believed
Absent
Maximum
Discarge Daily
(equi e
Maximum
Monthly
(d) Discharge
if available)
Long -Term
Average
Daily
Discharge
if available
Number
of
Analyses
Long -
Term
Average
Value
Number
of
Analyses
5.12
R-endosulfan
(115-29-7)
❑
❑
❑
Concentration
Mass
5.13
Endosulfan sulfate
(1031-07-8)
El
❑
❑
Concentration
Mass
5.14
Endrin
(72-20-8)
El
❑
❑
Concentration
Mass
5.15
Endrin aldehyde
(7421-93-4)
❑
❑
❑
Concentration
Mass
5.16
Heptachlor
(76-44-8)
❑
❑
❑
Concentration
Mass
5.17
Heptachlor epoxide
(1024-57-3)
❑
❑
Concentration
Mass
5.18
PCB-1242
(53469-21-9)
❑
❑
0
Concentration
Mass
5.19
PCB-1254
(11097-69-1)
❑
❑
0
Concentration
Mass
5.20
PCB-1221
(11104-28-2)
❑
❑
0
Concentration
Mass
5.21
PCB-1232
(11141-16-5)
❑
❑
Concentration
Mass
5.22
PCB-1248
(12672-29-6)
❑
❑
0
Concentration
Mass
5.23
PCB-1260
(11096-82-5)
❑
❑
0
Concentration
Mass
5.24
PCB-1016
(12674-11-2)
❑
❑
✓❑
Concentration
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
NCOO8E NCOO88714 Lassiter Farms Community Well 001 OMB No. 2040-0004
AITD
Presence or Absence
Intake
check one
Effluent
(optional)
Pollutant/Parameter
Testing
Units
Maximum
Maximum
Long -Term
Long -
(and CAS Number, if available)
Required
Believed
Believed
(specify)
Daily
Mony
thl
Average
Number
Term
Number
Present
Absent
Discharge
Discharge
Daily
of
Average
of
(required)
(if available)
Discharge
Analyses
Value
Analyses
f available
Toxaphene
Concentration
5.25 (8001-35-2)
0
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
NCOO88714 NCOO88714 Lassiter Farms Community Well 001 OMB No. 2040-0004
\A/Tn
Presence or Absence Intake
check one Effluent (Optional)
Pollutant Units Believed Believed (specify) Maximum Daily Maximum Long -Term Long -Term
Monthly Average Daily Number of Number of
Present Absent Discharge Average
Discharge Discharge Analyses Analyses
(required)
if available if available)Value
❑ Check here if you believe all pollutants on Table C to be present in your discharge from the noted outfall. You need not complete the "Presence or Absence" column of Table C for
each pollutant.
❑ Check here if you believe all pollutants on Table C to be absent in your discharge from the noted outfall. You need not complete the "Presence or Absence" column of Table C for
each pollutant.
1
Bromide
❑
❑
Concentration
Mass
(24959-67-9)
2
Chlorine, total
❑
❑
Concentration
Mass
residual
3.
Color
El
❑
Concentration
Mass
4.
Fecal coliform
❑
El
Concentration
Mass
5
Fluoride
❑
❑
Concentration
Mass
(16984-48-8)
6
Nitrate -nitrite
❑
❑
Concentration
Mass
7.
Nitrogen, total
El
❑
Concentration
Mass
organic (as N)
8.
Oil and grease
❑
❑
Concentration
Mass
9
Phosphorus (as
❑
❑
Concentration
Mass
P), total (7723-14-0)
10.
Sulfate (as SO4)
❑
❑
Concentration
Mass
(14808-79-8)
11.
Sulfide (as S)
❑
©
Concentration
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
NCO088714 NCO088714 Lassiter Farms Community Well 001 OMB No. 2040-0004
1 A =
Presence or Absence Intake
check one Effluent (Optional)
Pollutant Units Believed Believed (specify) Maximum Daily Maximum Long -Term Long -Term
Monthly Average Daily Number of Number of
Present Absent Discharge Average
Discharge Discharge Analyses Analyses
(required) Value
if available if available
12
Sulfite (as S03)
❑
Concentration
Mass
(14265-45-3)
13.
Surfactants
Concentration
Mass
14.
Aluminum, total
❑
Concentration
Mass
(7429-90-5)
15.
Barium, total
❑
Concentration
Mass
(7440-39-3)
16.
Boron, total
1:1
El
Concentration
Mass
(7440-42-8)
17.
Cobalt, total
❑
❑
Concentration
Mass
(7440-48-4)
18
Iron total
❑
❑
Concentration
Mass
(7439-89-6)
19
Magnesium, total
Concentration
Mass
(7439-95-4)
Molybdenum,
Concentration
20.
total
❑
❑
7439-98-7
Mass
21
Manganese, total
Concentration
Mass
(7439-96-5)
22
Tin, total
Concentration
Mass
(7440-31-5)
23
Titanium, total
❑
❑
Concentration
Mass
(7440-32-6)
EPA Form 3510-2C (Revised 3-19) Page 24

EPA Identification Number
NPDES Permit Number
Facility Name
Outfall Number
Form Approved 03/05/19
NCOO88714
NCOO88714
Lassiter Farms Community Well 001
\A/Tn
OMB No. 2040-0004
Presence or Absence
Intake
check one
Effluent
(Optional)
Pollutant
Believed
Believed
Units
(specify)
Maximum Daily
Maximum Long -Term
Long -Term
Present
Absent
Discharge
Monthly Average Daily Number of
Number of
Average
(required)
Discharge Discharge Analyses
Analyses
Value
if available if available
24.
Radioactivity
Alpha, total
❑
❑
Concentration
Mass
Beta, total
❑
❑
Concentration
Mass
Radium, total
El❑
Concentration
Mass
Radium 226, total
El
ElConcentrationMass
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
NCO088714 NCO088714 Lassiter Farms Community Well 001 OMB No. 2040-0004
niTn
21
Presence or Absence
Pollutant check one Reason Pollutant Believed Present in Discharge Available Quantitative Data
Believed Believed (specify units)
Present Absent
1.
Asbestos
❑
✓❑
2.
Acetaldehyde
❑
✓❑
3.
Allyl alcohol
❑
❑✓
4.
Allyl chloride
❑
❑✓
5.
Amyl acetate
❑
❑✓
6.
Aniline
❑
❑✓
7.
Benzonitrile
❑
121
8.
Benzyl chloride
❑
❑✓
9.
Butyl acetate
❑
❑✓
10.
Butylamine
❑
✓❑
11.
Captan
❑❑
12.
Carbaryl
❑
❑✓
13.
Carbofuran
❑
❑✓
14.
Carbon disulfide
❑
❑✓
15.
Chlorpyrifos
❑
❑✓
16.
Coumaphos
❑
❑✓
17.
Cresol
❑
❑✓
18.
Crotonaldehyde
❑
❑✓
19.
Cyclohexane
❑
❑�
EPA Form 3510-2C (Revised 3-19) Page 27

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NCO088714 NCO088714 Lassiter Farms Community Well 001 OMB No. 2040-0004
niTn
Presence or Absence
Pollutant check one Reason Pollutant Believed Present in Discharge Available Quantitative Data
Believed Believed (specify units)
Present Absent
20.
2,4-D (2,4-dichlorophenoxyacetic acid)
❑
✓❑
21.
Diazinon
❑
✓❑
22.
Dicamba
❑
❑�
23.
Dichlobenil
❑
❑✓
24.
Dichlone
❑
El
25.
2,2-dichloropropionic acid
❑
❑✓
26.
Dichlorvos
❑
❑✓
27.
Diethyl amine
❑
❑✓
28.
Dimethyl amine
❑
❑✓
29.
Dintrobenzene
❑
❑✓
30.
Diquat
❑
❑�
31.
Disulfoton
❑
❑✓
32.
Diuron
❑
❑✓
33.
Epichlorohydrin
❑
❑✓
34.
Ethion
❑
❑✓
35.
Ethylene diamine
❑
❑✓
36.
Ethylene dibromide
❑
❑✓
37.
Formaldehyde
❑
❑✓
38.
Furfural
❑
❑✓
EPA Form 3510-2C (Revised 3-19) Page 28

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NCO088714 NCO088714 Lassiter Farms Community Well 001 OMB No. 2040-0004
niTn
1 '1� 1 1
Presence or Absence
Pollutant check one Reason Pollutant Believed Present in Discharge Available Quantitative Data
Believed Believed (specify units)
Present Absent
39.
Guthion
❑
❑✓
40.
Isoprene
❑
❑✓
41.
Isopropanolamine
❑
❑✓
42.
Kelthane
❑
❑✓
43.
Kepone
❑
❑✓
44.
Malathion
❑
❑✓
45.
Mercaptodimethur
❑
❑✓
46.
Methoxychlor
❑
❑✓
47.
Methyl mercaptan
❑
✓❑
48.
Methyl methacrylate
❑
49.
Methyl parathion
❑
❑�
50.
Mevinphos
❑
❑✓
51.
Mexacarbate
❑
❑✓
52.
Monoethyl amine
❑
❑✓
53.
Monomethyl amine
❑
❑✓
54.
Naled
❑
❑✓
55.
Naphthenic acid
❑
❑�
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
NCO088714 NCO088714 Lassiter Farms Community Well 001 OMB No. 2040-0004
niTn
Presence or Absence
Pollutant check one Reason Pollutant Believed Present in Discharge Available Quantitative Data
Believed Believed (specify units)
Present Absent
58.
Phenolsulfonate
❑
❑✓
59.
Phosgene
❑
❑✓
60.
Propargite
❑
❑✓
61.
Propylene oxide
❑
❑✓
62.
Pyrethrins
❑
❑✓
63.
Quinoline
❑
❑✓
64.
Resorcinol
❑
❑✓
65.
Strontium
❑
✓❑
66.
Strychnine
❑
✓❑
67.
Styrene
❑
❑✓
68
2,4 5-T (2,4,5-trichlorophenoxyacetic
acid
❑
❑
69.
TIDE (tetrachlorodiphenyl ethane)
❑
❑�
70
2,4,5-TP [2-(2,4,5-trichlorophenoxy)
ro anoic acid
El❑
71.
Trichlorofon
❑
❑✓
72.
Triethanolamine
❑
❑�
73.
Triethylamine
❑
❑�
74.
Trimethylamine
❑
❑✓
75.
Uranium
❑
10
76.
Vanadium
❑
M
EPA Form 3510-2C (Revised 3-19) Page 30

EPA Identification Number
NPDES Permit Number Facility Name Outfall Number
Form Approved 03/05/19
NCOO88714
NCOO88714 Lassiter Farms Community Well 001
niTn
OMB No. 2040-0004
1 '1�
1 1
Presence or Absence
Pollutant
check one Reason Pollutant Believed Present in Discharge
Available Quantitative Data
Believed Believed
(specify units)
Present Absent
77.
Vinyl acetate
❑
✓❑
78.
Xylene
❑
El
79.
Xylenol
❑
✓❑
80.
Zirconium
❑
✓❑
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C (Revised 3-19) Page 31

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EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NCOO88714 NC0088714 Lassiter Farms Community Well OMB No. 2040-0004
%A I-M
TCDD Presence or
Congeners Absence
Pollutant Used or check one Results of Screening Procedure
Manufactured Believed Believed
Present Absent
2,3,7,8-TCDD ❑ ❑ 0
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EPA Form 3510-2C (Revised 3-19) Page 33