NC0089451_Renewal (Application)_20240205

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
John Cates
Addis Cates Company Incorporated
PO Box 146
Parkton, NC 28371-0146
Subject: Permit Renewal
Application No. NCO089451
former Cates Brinery
Robeson County
Dear Applicant:
NORTH CAROLINA
Environmental Quality
February 05, 2024
The Water Quality Permitting Section acknowledges the February 5, 2024 receipt of your permit renewal application and
supporting documentation. Your application will be assigned to a permit writer within the Section's NPDES WW permitting
branch. Per G.S. 150E-3 your current permit does not expire until permit decision on the application is made.
Continuation of the current permit is contingent on timely and sufficient application for renewal of the current permit. The
permit writer will contact you if additional information is required to complete your permit renewal. Please respond in a
timely manner to requests for additional information necessary to allow a complete review of the application and renewal
of the permit.
Information regarding the status of your renewal application can be found online using the Department of Environmental
Quality's Environmental Application Tracker at:
https•//deq nc gov/permits-regulations/permit-guidance/environmental-application-tracker
If you have any additional questions about the permit, please contact the primary reviewer of the application using the
links available within the Application Tracker.
Sincerely,
Cynthia Demery
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application
North Carolina Department of F-fronmental Quality I Division of Water Resources
FayetteAle Regional Office 1 225 Green Street. Suite 714 1 Fayettevipe. North Carolina 28301
o.«.:iiu.+•....+orw� /'� 910.4333300

13
ADDIS CATES COMPANY, INC.
PARKTON, NORTH CAROLINA 28371
TELEPHONE [phone]
FAX [phone]
January 31, 2024
NC DEQ/DWR/Water Quality Permitting Section/NPDES
1617 Mail Service Center
Raleigh, NC 27699-1617
Subject: NPDES Permit Renewal Application
Addis Cates Company Inc.
Former Cates Brinery
NPDES Permit No. NCO089451
Dear NPDES Permitting Unit,
RECEIVED
FEB 0 5 2024
NCDEQ/DWR/NPDES
Enclosed is one original and one copy of the NPDES permit renewal application (EPA Form 1, 2C,
and 2E) and a brief narrative found in this cover letter explaining the groundwater remediation
for the Former Cates Brinery located in Robeson County.
The recovery well water containing sodium chloride mixes with the dilution well water in outfall
001 and then discharged to Dunns Marsh in the Lumber River.
The Addis Cates Company Inc. request a wavier for monitoring of turbidity, copper, mercury,
selenium, and silver. These parameters are below detection and there have been no changes to
the facility or effluent characteristics since the permit issuance.
Thank you for your assistance in processing this application. If you have questions or require
additional information, please feel free to contact me at (910) 237-511, or via email at
[e-mail].
Sincerely,
Ah B. CatWk
es
President

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
110062664255
NCO089451
Former Cates Brinery
OMB No. 2040-0004
Form
U.S. Environmental Protection Agency
1
\"/EPA
Application for NPDES Permit to Discharge Wastewater
NPDES
GENERAL INFORMATION
SECTION•
•Dt
Applicants Not Required to Submit Form 1
1.1
1.1.1
Is the facility a new or existing publicly owned
1.1.2
Is the facility a new or existing treatment works
treatment works?
treating domestic sewage?
If yes, STOP. Do NOT complete 0 No
If yes, STOP. Do NOT Fv No
Form 1. Complete Form 2A.
complete Form 1. Complete
Form 2S.
1.2
Applicants Required to Submit Form 1
1.2.1
Is the facility a concentrated animal feeding
1.2.2
Is the facility an existing manufacturing,
operation or a concentrated aquatic animal
commercial, mining, or silvicultural facility that is
a
production facility?
currently discharging process wastewater?
oYes
4 Complete Form 1 No
Yes 4 Complete Form ❑ No
a
and Form 213.
1 and Form 2C.
z
r-
1.2.3
Is the facility a new manufacturing, commercial,
1.2.4
Is the facility a new or existing manufacturing,
a�
mining, or silvicultural facility that has not yet
commercial, mining, or silvicultural facility that
commenced to discharge?
discharges only nonprocess wastewater?
C
❑ Yes 4 Complete Form 1 No
Yes 4 Complete Form No
and Form 2D.
1 and Form 2E.
N
1.2.5
Is the facility a new or existing facility whose
'—
discharge is composed entirely of stormwater
a
associated with industrial activity or whose
discharge is composed of both stormwater and
non-stormwater?
Yes -+ Complete Form 1 r✓ No
and Form 2F
unless exempted by
40 CFR
122.26(b)(14)(x) or
b (15).
SECTIONDD•
• • i
2.1
Facility Name
Former Cates Brinery Ground Water Remediation Site
0
2.2
EPA Identification Number
C
J
110062664255
"a
2.3
Facility Contact
Name (first and last)
Title
Phone number
a
John B. Cates
President
[phone]
Q
Email address
[e-mail]
2.4
Facility Mailing Address
M
Street or P.O. box
z
Post Office Box 146
City or town
State
ZIP code
Parkton
NC
28371-0146
EPA Form 3510-1 (revised 3-19) Page 1

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
110062664255
NCO089451
Former Cates Brinery
OMB No.2040-0004
v;
2.5
Facility Location
Street, route number, or other specific identifier
Q 0
U
2640 McIver Road
rn
0
County name
County code (if known)
Robeson
E
City or town
State ZIP code
`O
z �
Parkton
NC 28371-0146
SECTION
3. SIC
AND NAICS ODi
Description (optional)
3.1
SIC Code(s)
0
U
U
Z
3.2
NAICS Code(s)
Description (optional)
a
U
rn
SECTION
4. OPERATOR
INFORMATION (40
Name of Operator
4.1
Addis Cates Company, Inc.
0
4.2
Is the name you listed in Item 4.1 also the owner?
0
0 Yes ❑ No
w
4.3
Operator Status
❑ Public —federal ❑ Public —state ❑ Other public (specify)
o
❑✓ Private ❑ Other (specify)
4.4
Phone Number of Operator
[phone]
=
4.5
Operator Address
w
Street or P.O. Box
15
E
P.O. Box 146
0
= w
City or town
State
ZIP code
`0 0
Parkton
INC
28371-0146
� U
a
Email address of operator
O
[e-mail]
-0
Is the facility located on Indian Land?
v 0
5.1
❑ Yes ❑ No
EPA Form 3510-1 (revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
110062664255 NCO089451 Former Cates Brinery OMB No.2040-0004
SECTION••
1 CFR 122.21(ffl6))
6.1
Existing Environmental Permits (check
all that apply and print or type the corresponding permit number for each)
❑✓ NPDES (discharges to surface
❑ RCRA (hazardous wastes)
❑ UIC (underground injection of
water)
fluids)
NCO089451
w a
❑ PSD (air emissions)
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
rn
c
w
ElOcean dumping (MPRSA) ❑ Dredge or fill (CWA Section 404) ElOther (specify)
SECTIONI
Have you attached a topographic map containing all required information to this application? (See instructions for
7.1
C
specific requirements.)
✓❑ Yes ❑ No ❑ CAFO—Not Applicable (See requirements in Form 2B.)
SECTIONOF
1
Describe the nature of your business.
8.1
Former Cates Brinery Ground Water Remediation Site is a treatment system to remediate groundwater
contaminated with sodium chloride from facilities located at the Former Cates Brinery located at Addis Cates
d
Company, Inc., 2640 McIver Road in Parkton, INC. The recovery well water (sodium chloride) is diluted with dilution
c
3
well water and discharged to Dunns Marsh to meet chloride permit limits.
m
0
d
iv
z
SECTION'
COOLING WATER INTAKE STRUCTURES (40
9.1 Does your facility use cooling water?
❑ Yes ❑r No 4 SKIP to Item 10.1.
3
9.2
Identify the source of cooling water. (Note that facilities that use a cooling water intake structure as described at
rn:
40 CFR 125, Subparts I and J may have additional application requirements at 40 CFR 122.21(r). Consult with your
o Y
NPDES permitting authority to determine what specific information needs to be submitted and when.)
o �
U c
SECTION1
VARIANCE
REQUESTS1 I
Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(m)? (Check all that
10.1
apply. Consult with your NPDES permitting authority to determine what information needs to be submitted and
N
CD
when.)
C
❑ Fundamentally different factors (CWA ❑ Water quality related effluent limitations (CWA Section
d
Section 301(n)) 302(b)(2))
❑ Non -conventional pollutants (CWA ❑ Thermal discharges (CWA Section 316(a))
Section 301(c) and (g))
R Not applicable
EPA Form 3510-1 (revised 3-19) Page 3

EPA Identification Number
NPDES Permit Number
Facility Name Form Approved 03/05/19
110062664255
NCO089451
Former Cates Brinery OMB No. 2040-0004
SECTION•
11.1
1
In Column 1 below, mark the sections of Form 1 that you have completed and are submitting with your application.
For each section, specify in Column 2 any attachments that you are enclosing to alert the permitting authority. Note
that not all applicants are required to provide attachments.
Column 1
Column 2
0 Section 1: Activities Requiring an NPDES Permit
❑ w/ attachments
Section 2: Name, Mailing Address, and Location
❑ w/ attachments
❑✓ Section 3: SIC Codes
❑ w/ attachments
P'l Section 4: Operator Information
❑ w/ attachments
❑✓ Section 5: Indian Land
❑ w/ attachments
❑r Section 6: Existing Environmental Permits
❑ w/ attachments
d
7M
❑ Section : Map
El w/ additional attachments
in
o
Section 8: Nature of Business
❑ w/ attachments
:'
❑� Section 9: Cooling Water Intake Structures
❑ w/ attachments
❑✓ Section 10: Variance Requests
❑ w/ attachments
a
c
y
❑✓ Section 11: Checklist and Certification Statement
❑ w/ attachments
Y
11.2
Certification Statement
U
1 certify under penalty of law that this document and all attachments were prepared under my direction or supervision
in accordance with a system designed to assure that qualified personnel properly gather and evaluate the
information submitted. Based on my inquiry of the person or persons who manage the system, or those persons
directly responsible for gathering the information, the information submitted is, to the best of my knowledge and
belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possibility of fine and imprisonment for knowing violations.
Name (print or type first and last name)
Official title
John B. Cates
President
Signatu 1
Date si ed
v
EPA Form 3510-1 (revised 3-19) Page 4

EPA Identification Number
110062664255
Form
NP ES �`�EPA
NPDES Permit Number Facility Name Form Approved 03/05/19
NCO089451 Former Cates Brinery OMB No. 2040-0004
U.S. Environmental Protection Agency
Application for NPDES Permit to Discharge Wastewater
EXISTING MANUFACTURING, COMMERCIAL, MINING, AND SILVICULTURE OPERATIONS
1.1 Provide information on each of the facilii
Numbel w r Receiving Water Name
v
0 001 Dunns Marsh34
J
N
O
outfalls in the table below.
Latitude
34' 53' 45" N
o
Longitude
79' 01, 05" W
o
a, 2.1 Have you attached a line drawing to this application that shows the water flow through you F#�iJiI%pter
_ 3 balance? (See instructions for drawing requirements. See Exhibit 2C-1 at end of instructio
J �
0 0 Yes ❑ No KInnt-n,r„Air,,..
3.1 For each outfall identified under Item 1.1, provide average flow and treatment information. Add additional sheets if
necessary.
'"Outfall Number"* 001
Operation Average Flow
Recovery ( Sodium chloride) Water Well 0.00576 mgd
c
E Dilution (Ground Water) Water Well 0.01584 mgd
io
P mgd
y mgd
3
0 Treatment Units
LL
Description Final Disposal of Solid or
(include size, flow rate through each treatment unit, Code from Liquid Wastes Other Than
aretention time, etc.) Table 2C-1 by Discharge
EPA Form 3510-2C (Revised 3-19) Page 1

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
110062664255
NCO089451
Former Cates Brinery
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
-o
_
0
U
_
as
E
ca
a>
L
H
**Outfall Number**
Operations Contributing
to Flow
o
Operation
Average Flow
U-
a,
mgd
L
¢'
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 -* SKIP to Section 4.
3.3
Have you attached a list that identifies each user of the treatment works?
Cn
❑ Yes ❑ No
EPA Form 3510-2C (Revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05119
110062664255 NCO089451 Former Cates Brinery OMB No.2040-0004
SECTION• 1
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 ouffall.
Attach additional pages, if n cessary.
Frequency
Flow
Rate
Outfall
Operation
Duration
Average
Average
Long -Term
Maximum
Number
(list)
Da sMeek
MonthsNear
Average
Dail
days/week
months/year
mgd
mgd
days
N
o
days/week
months/year
mgd
mgd
days
U_
c
days/week
months/year
mgd
mgd
days
a>
E
`m
days/week
months/year
mgd
mgd
days
days/week
monthslyear
mgd
mgd
days
c
days/week
months/year
mgd
mgd
days
days/week
months/year
mgd
mgd
days
days/week
months/year
mgd
mgd
days
days/week months/year mgd mgd days
SECTION•••D
• 1
Do any effluent limitation guidelines (ELGs) promulgated by EPA under Section 304 of the CWA apply to your facility?
5.1
❑ Yes 0 No -+ SKIP to Section 6.
v,
5.2
Provide the following information on applicable ELGs.
ELG Category
ELG Subcategory
Regulatory Citation
w
d
�o
U
a
Q
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
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
Measure
Number
d
tll
N
m
C
O
U
7
O
a
EPA Form 3510-2C (Revised 3-19) Page 3

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
110062664255 NCO089451 Former Cates Brinery OMB No. 2040-0004
IMPROVEMENTSSECTION 6. 1
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
o
Project
(list outfall
Discharge
Required
Projected
CL
number
E
c
d)
G1
!O
i
O7
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 0 Not applicable
CHARACTERISTICS
See the instructions to determine the pollutants and parameters you are required to monitor and, in turn, the tables you must
complete. Not all applicants need to complete each table.
Table A. Conventional and Non -Conventional Pollutants
7.1
Are you requesting a waiver from your NPDES permitting authority for one or more of the Table A pollutants for any of
your outfalls?
❑ Yes ❑ No -+ 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?
No; a waiver has been requested from my NPDES
❑ Yes ❑permitting
i
auth rity 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.
W
7.5
Have you checked "Testing Required" for all toxic metals, cyanide, and total phenols in Section 1 of Table B?
w
❑ Yes 0 No
7.6
List the applicable primary industry categories and check the boxes indicating the required GUMS fraction(s) identified
in Exhibit 2C-3.
Required GCIMS Fraction(s)
Primary Industry Category
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
110062664255
NCO089451
Former Cates Brinery
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
0
determined testing is required or (2) quantitative data or an explanation for those Sections 2 through 5, Table B,
pollutants you have indicated are 'Believed Present' in your discharge?
`—'
.N
El 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
0 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'?
c
Z Yes ❑ No
w
Table D. Certain Hazardous Substances and Asbestos
7.14
Have you indicated whether pollutants are `Believed Present' or "Believed Absent' for all pollutants listed in Table D for
all outfalls?
r❑ 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?
❑r Yes ❑ No
Table E. 2,3,7,8-Tetrachlorodibenzo-p-Dioxin 2,3,7,8-TCDD
7.16
Does the facility use or manufacture one or more of the 2,3,7,8-TCDD congeners listed in the instructions, or do you
know or have reason to believe that TCDD is or may be present in the effluent?
❑ Yes + Complete Table E. ❑ No 4 SKIP to Section 8.
7.17
Have you completed Table E by reporting qualitative data for TCDD?
0 Yes ❑ No
SECTIONOR
MANUFACTURED TOXICSi
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
U
❑ Yes ❑✓ No 4 SKIP to Section 9.
U)
8.2
List the pollutants below.
i0
1. 4. 7.
0
d
2. 5. 8.
3. 6. 9.
EPA Form 3510-2C (Revised 3-19) Page 5

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
110062664255 NCO089451 Former Cates Brinery OMB No. 2040-0004
MCTION ' 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.
y
U)
0
9.2
Identify the tests and their
ur oses below.
.5
Test(s)
Purpose of Test(s)
Submitted to NPDES
Date Submitted
x
Permitting Authority?
0
❑ Yes ❑ No
v
0
o
m
❑ Yes ❑ No
❑ Yes ❑ No
E-ECTION
10. CONTRACTi
Were any of the analyses reported in Section 7 performed by a contract laboratory or consulting firm?
10.1
❑ Yes ✓❑ No -+ 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
N
a
Laboratory address
R
_
w
0
Phone number
Pollutant(s) analyzed
SECTIONADDITIONAL
11.1
INFORMATION
Has the NPDES permitting authority requested additional information?
_
❑ Yes ❑r No 4 SKIP to Section 12.
0
L
11.2
List the information requested and attach it to this application.
0
1. 4.
R
0
2. 5.
a
3. 6.
EPA Form 3510-2C (Revised 3-19) Page 6

EPA Identification Number
NPDES Permit Number Facility Name Form Approved uj/uona
110062664255
Former Cates Brinery OMB No.2040-0004
SECTION1
CERTIFICATION STATEMENT (40
In Column 1 below, mark the sections of Form 2C that you have completed and are submitting with your application.
12.1
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 com lete all sections or provide attachments.
Column 1
Column 2
❑✓ Section 1: Outfall Location
❑ wl attachments
Section 2: Line Drawing
❑ wl line drawing ❑ wl additional attachments
w/ list of each user of
❑ Section 3: Average Flows and
❑ w/ attachments ❑ privately owned treatment
Treatment
works
❑ Section 4: Intermittent Flows
❑ w/ attachments
❑ Section 5: Production
❑ wl attachments
w/ optional additional
❑ Section 6: Improvements
❑ wl attachments ❑ sheets describing any
additional pollution control
tans
❑ w/ request for a waiver and ❑ wl explanation for identical
supporting information outfalls
❑ wl small business exemption ❑ wl other attachments
d
request
❑ Section 7: Effluent and Intake
0 w/ Table A ❑r w/ Table B
c
Characteristics
❑r wl Table C ❑ wl Table D
v
❑ wl Table E ❑ w/ analytical results as an
attachment
Section 8: Used or Manufactured
El
❑ wl attachments
�,
Toxics
❑ Section 9: Biological Toxicity
❑ wl attachments
Tests
U
❑ Section 10: Contract Analyses
❑ w/ attachments
❑ Section 11: Additional Information
❑ wl attachments
✓❑ Section 12: Checklist and
❑ w/ attachments
Certification Statement
12.2
Certification Statement
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly
responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false information, including the
possibility of fine and imprisonment for knowing violations.
Name (print or type first and last name)
Official title
John B. Cates
President
Signature
Date signed
EPA Form 3510-2C (Revised 3-19) Page 7

This page intentionally left blank.

EPA Identification Number i NPDES
110062664255
Facility Name
Former Cates Brinery
Outfall Number
Form Approved 03/05/19
OMB No. 2040-0004
Effluent
Intake
TABLE A. CONVENTIONAL AND NON•
• • • 1
0 tional
Waiver
Units
Maximum
Maximum
Long -Term
Pollutant
Requested
(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
El
Concentration
(BOD5)
Mass
2'
Chemical oxygen demand
El
Concentration
Concentration
(COD)
Concentration
3.
Total organic carbon (TOC)
❑
Mass
Concentration
4.
Total suspended solids (TSS)
El
Mass
Concentration
5.
Ammonia (as N)
❑
Mass
6.
Flow
❑
Rate
Temperature (winter)
❑
°C
°C
7.
Temperature (summer)
❑
°C
°C
pH (minimum)
❑
Standard units
S.U.
8.
pH (maximum)
❑
Standard units
S.U.
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters of
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
110062664255
Number Facility Name
Former Cates Brinery
Outfall Number
Form Approved 03/05/19
OMB No. 2040-0004
TABLE B. TOXIC METALS, CYANIDE,
TOTAL PHENOLS,
AND ORGANIC TOXIC
POLLUTANTS (40 CFR
122.21(g)(7)(v))'
Effluent
Intake
(optional)
Pollutant/Parameter
(and CAS Number, if available)
Testing
Required
Presence or Absence
check one
Units
(specify)
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
g
if available
Number
of
Analyses
Long -
Term
Average
Value
Number
of
Analyses
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
(7440-36-0)
ElConcentration
Mass
1.2
Arsenic, total
(7440-38-2)
❑
❑
Concentration
Mass
1.3
Beryllium, total
(7440-41-7)
El
❑
ElConcentration
Mass
1.4
Cadmium, total
(7440-43-9)
El
❑
Concentration
Mass
1.5
Chromium, total
(7440-47-3)
El
11
El
Concentration
Mass
1.6
Copper, total
(7440-50-8)
El
Concentration
Mass
1.7
Lead, total
(7439-92-1)
El
Concentration
Mass
1.8
Mercury, total
(7439-97-6)
❑
Concentration
Mass
1.9
Nickel, total
(7440-02-0)
El
ElConcentration
Mass
1.10
Selenium, total
(7782-49-2)
0
El
Concentration
Mass
1.11
Silver, total
(7440-22-4)
El
El
El
Concentration
Mass
EPA Form 3510-2C (Revised 3-19) Page 11

EPA Identification Number
110062664255
NPDES Permit Number Facility Name
Former Cates Brinery
Outfall Number
Form Approved 03/05/19
OMB No. 2040-0004
•
•
• 1 •
• • •
Effluent
Intake
(optional)
Pollutant/Parameter
(and CAS Number, if available )
Testing
Required
q
Presence or Absence
check one
Units
(specify)
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
if available
Number
of
Analyses
Long-
Term
Average
Value
Number
of
Analyses
1.12
Thallium, total
(7440-28-0)
El
El
Concentration
Mass
1.13
Zinc total
(7440-66-6)
El
El
ElConcentration
Mass
1.14
Cyanide, total
(57-12-5)
El
El
❑
Concentration
Mass
1.15
Phenols, total
El
❑
Concentration
Mass
Section 2.Organic Toxic Pollutants (GC/MS Fraction
—Volatile Compounds)
21
Acrolein
(107-02-8)
El
El
Concentration
Mass
2.2
Acrylonitrile
(107-13-1)
El
El
El
Concentration
Mass
2.3
Benzene
(71-43-2)
El
1:1
El
Concentration
Mass
2.4
Bromoform
(75-25-2)
❑
❑
Concentration
Mass
2.5
Carbon tetrachloride
(56-23-5)
El
El
11
Concentration
Mass
2.6
Chlorobenzene
(108-90-7)
❑
Concentration
Mass
2 7
Chlorodibromomethane
(124-48-1)
❑
❑
Concentration
Mass
2.8
Chloroethane
(75-00-3)
Concentration
Mass
EPA Form 3510-2C (Revised 3-19) Page 12

EPA Identification Number
110062664255
rmit Number Facility Name
Former Cates Brinery
Outtall Number
Form Approved 03/05/19
OMB No. 2040-0004
Rielf-'142W.
MOSS
Intake
Presence or Absence
check one
Effluent
(optional)
Pollutant/Parameter
(and CAS Number, if available)
Testing
Required
Believed
Believed
Units
(specify)
Maximum
Maximum
Long -Term
Average
Number
Long -
Term
Number
Present
Absent
Daily
Discharge
Monthly
Discharge
Daily
Discharge
g
of
Analyses
Average
of
Analyses
(required)
(if available)
f available
Value
2.9
2-chloroethylvinyl ether
❑
Concentration
(110-75-8)
Mass
2.10
Chloroform (67-66-3)
❑
❑
❑
Concentration
Mass
2.11
Dichlorobromomethane
❑
Concentration
(75-27-4)
Mass
212
11-dichloroethane
❑
❑
❑
Concentration
(75-34-3)
Mass
2.13
1 2-dichloroethane
El
El
El
Concentration
(107-06-2)
Mass
2.14
1,1-dichloroethylene
El
❑
❑
Concentration
(75-35-4)
Mass
2.15
12-dichloropropane
❑
❑
El
Concentration
(78-87-5)
Mass
2.16
1 3-dichloropropylene
El
1:1
El
Concentration
(542-75-6)
Mass
2.17
Ethylbenzene
Concentration
(100-41-4)
Mass
2.18
Methyl bromide
❑
Concentration
(74-83-9)
Mass
2.19
Methyl chloride
❑
❑
❑
Concentration
(74-87-3)
Mass
2.20
Methylene chloride
❑
❑
❑
Concentration
(75-09-2)
Mass
2.21
1 1,2,2- tetrachloroethane
El
Concentration
(79-34-5)
Mass
EPA Form 3510-2C (Revised 3-19) Page 13

EPA Identification Number NPDES Permit Number
Facility Name
Outfall Number Form Approved 03/05/19
LOMB No. 2040-0004
110062664255
Former Cates Brinery
TABLE B. TOXIC METALS, CYANIDE,
TOTAL PHENOLS,
AND ORGANIC TOXIC
POLLUTANTS (40 CFR
122.21(g)(7)(v))'
Intake
Presence or Absence
check one
Effluent
(optional)
Poll utant/Parameter
(and CAS Number, if available)
Testing
Required
Believed
Believed
Units
(specify)
Maximum
Maximum
Long -Term
Average
Number
Lon 9 -
Term
Number
Present
Absent
Daily
Discharge
Monthly
Discharge
Daily
Discharge
g
of
Analyses
Average
of
Analyses
(required)
(if available)
f available
Value
2.22
Tetrachloroethylene
❑
❑
El
Concentration
(127-18-4)
Mass
2.23
Toluene
❑
❑
❑
Concentration
(108-88-3)
Mass
2.24
1,2-trans-dichloroethylene
❑
❑
❑
Concentration
(156-60-5)
Mass
2.25
1 1,1-trichloroethane
❑
❑
Concentration
(71-55-6)
Mass
2.26
1 1,2-trichloroethane
El
El
❑
Concentration
(79-00-5)
Mass
2.27
Trichloroethylene
❑
❑
El
Concentration
(79-01-6)
Mass
2.28
Vinyl chloride
El
Concentration
(75-01-4)
Mass
Section 3.Organic Toxic Pollutants (GC/MS Fraction
—Acid Compounds)
3.1
2-chlorophenol
El
1:1
Concentration
(95-57-8)
Mass
3.2
2 4-dichlorophenol
El
❑
Concentration
(120-83-2)
Mass
3.3
2,4-dimethylphenol
El
❑
Concentration
(105-67-9)
Mass
3.4
4 6-dinitro-o-cresol
Concentration
(534-52-1)
Mass
3.5
2,4-dinitrophenol
El
El
El
Concentration
(51-28-5)
Mass
EPA Form 3510-2C (Revised 3-19) Page 14

EPA Identification Number
110062664255
Number Facility Name
Former Cates Brinery
uuttau Number
Form Approved 03/05/19
OMB No. 2040-0004
Effluent
Intake
(optional)
Poll utant/Parameter
(and CAS Number, if available)
Testing
Required
Presence or Absence
check one
Units (specify)
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
if available
Number
of
Analyses
Lon g-
Term
Average
Value
Number
of
Analyses
3.6
2-nitrophenol
(88-75-5)
El
❑
❑
Concentration
Mass
3.7
4-nitrophenol
(100-02-7)
❑
El
Concentration
Mass
3 8
p-chloro-m-cresol
(59-50-7)
Concentration
Mass
3.9
Pentachlorophenol
(87-86-5)
El
❑
El
Concentration
Mass
3.10
Phenol
(108-95-2)
Concentration
Mass
3.11
2 4,6-trichlorophenol
(88-05-2)
El
El
Concentration
Mass
Section 4.Organic Toxic Pollutants (GC/MS Fraction
—Base /Neutral
Compounds)
4.1
Acenaphthene
(83-32-9)
Concentration
Mass
4.2
Acenaphthylene
(208-96-8)
❑
❑
Concentration
Mass
4.3
Anthracene
(120-12-7)
❑
❑
El
Concentration
Mass
4.4
Benzidine
(92-87-5)
❑
❑
❑
Concentration
Mass
4.5
Benzo (a) anthracene
(56-55-3)
❑
❑
Concentration
Mass
4.6
Benzo (a) pyrene
(50-32-8)
❑
❑
El
Concentration
Mass
EPA Form 3510-2C (Revised 3-19) Page 15

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No. 2040-0004
110062664255 Former Cates Brinery
Intake
Presence or Absence
check one
Effluent
(optional)
Pollutant/Parameter
(and CAS Number, if available)
(and
Testing
Required
Believed
Believed
Units
(specify)
Maximum
Long -Term
Average
Number
Long -
g
Term
Number
Present
Absent
Daily
Discharge
Monthly
Discharge
Daily
Discharge
of
Analyses
Average
of
Analyses
(required)
(if available)
if available
Value
4 7
3 4-benzofluoranthene
�
�
�
Concentration
(205-99-2)
Mass
4.8
Benzo (ghi) perylene
❑
Concentration
(191-24-2)
Mass
4 9
Benzo (k) fluoranthene
❑
Concentration
(207-08-9)
Mass
4.10
Bis (2-chloroethoxy) methane
❑
❑
Concentration
(111-91-1)
Mass
4.11
Bis (2-chloroethyl) ether
Concentration
(111-44-4)
Mass
4.12
Bis (2-chloroisopropyl) ether
❑
Concentration
(102-80-1)
Mass
4.13
Bis (2-ethylhexyl) phthalate
El
1:1
El
Concentration
(117-81-7)
Mass
4.14
4-bromophenyl phenyl ether
El
El
El
Concentration
(101-55-3)
Mass
4.15
Butyl benzyl phthalate
❑
El
❑
Concentration
(85-68-7)
Mass
4.16
2-chloronaphthalene
❑
❑
Concentration
(91-58-7)
Mass
4.17
4-chlorophenyl phenyl ether
Concentration
(7005-72-3)
Mass
4.18
Chrysene
Concentration
(218-01-9)
Mass
4.19
Dibenzo (a,h) anthracene
❑
El
Concentration
(53-70-3)
Mass
EPA Form 3510-2C (Revised 3-19) Page 16

EPA Identification Number
110062664255
NPDES Permit Number Facility Name
Former Cates Brinery
Outfall Number
Form Approved 03/05/19
OMB No. 2040-0004
• 1
•
• 1 •' TIM•
'• I
Intake
Presence or Absence
check one
Effluent
(optional)
Pollutant/Parameter
(and CAS Number, if available )
Testing
Required
y
Believed
Believed
Units
(specify)
Maximum
Maximum
Long -Term
Average
Number
Long-
Term
Number
Present
Absent
Daily
Discharge
Monthly
Discharge
Daily
of
Average
of
(required)
(if available)
Discharge
Analyses
Value
Analyses
if available
4.20
12-dichlorobenzene
El
❑
0
Concentration
(95-50-1)
Mass
4.21
13-dichlorobenzene
El
❑
Concentration
(541-73-1)
Mass
4.22
1 4-dichlorobenzene
❑
❑
Concentration
(106-46-7)
Mass
4.23
3 3-dichlorobenzidine
❑
11
❑
Concentration
(91-94-1)
Mass
4.24
Diethyl phthalate
❑
❑
❑
Concentration
(84-66-2)
Mass
4.25
Dimethyl phthalate
❑
❑
El
Concentration
(131-11-3)
Mass
4.26
Di-n-butyl phthalate
❑
Concentration
(84-74-2)
Mass
4.27
2 4-dinitrotoluene
El
El
1:1
Concentration
(121-14-2)
Mass
4.28
2 6-dinitrotoluene
El
11
El
Concentration
(606-20-2)
Mass
4.29
Di-n-octyl phthalate
El
El
11
Concentration
(117-84-0)
Mass
4.30
1,2-Diphenylhydrazine
El
❑
El
Concentration
(as azobenzene)(122-66-7)
Mass
4.31
Fluoranthene
Concentration
(20644-0)
Mass
L432
Fluorene
❑
❑
EiConcentration
(86-73-7)
Mass
EPA Form 3510-2C (Revised 3-19) Page 17

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

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No. 2040-0004
110062664255 Former Cates Brinery
Effluent
Intake
(optional)
Pollutant/Parameter
(and CAS Number, if available)
Testing
Required
Presence or Absence
check one
Units
(specify)
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
if available
Number
of
Analyses
-
Long -
Lon
Term
Average
Value
Number
of
Analyses
4.46
1 2 4-trichlorobenzene
(120-82-1) 1
❑
❑
❑
Concentration
Mass
Section 5.Organic Toxic Pollutants (GC/MS Fraction
—Pesticides)
5.1
Aldrin
(309-00-2)
❑
❑
Concentration
Mass
5.2
a-BHC
(319-84-6)
El
1:1
El
Concentration
Mass
5.3
R-BHC
(319-85-7)
El
El
El
Concentration
Mass
5.4
y-BHC
(58-89-9)
El
Concentration
Mass
F.6
b-BHC
(319-86-8)
Concentration
Mass
Chlordane
(57-74-9)
El
11
Concentration
Mass
5.7
4 4'-DDT
(50-29-3)
El
El
El
Concentration
Mass
5.8
4 4'-DDE
(72-55-9)
Concentration
Mass
5.9
4 4'-DDD
(72-54-8)
Concentration
Mass
5.10
Dieldrin
(60-57-1)
El
El
Concentration
Mass
5.11
a-endosulfan
(115-29-7)
11
Concentration
Mass
EPA Form 3510-2C (Revised 3-19) Page 19

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No. 2040-0004
110062664255 Former Cates Brinery
TABLE B. TOXIC METALS, CYANIDE, TOTAL
PHENOLS,
AND ORGANIC TOXIC
POLLUTANTS (40 CFR
122.21(g)(7)(v))'
Effluent
Intake
(optional)
Pollutant/Parameter
(and CAS Number, if available)
Testing
Required
Presence or Absence
check one
Units
(specify)
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
if available
Number
of
Analyses
Long -
Term
Average
Value
Number
of
Analyses
5.12
R-endosulfan
(115-29-7)
El
�
�
Concentration
Mass
5.13
Endosulfan sulfate
(1031-07-8)
❑
El
Concentration
Mass
5.14
Endrin
(72-20-8)
Concentration
Mass
5.15
Endrin aldehydeEl
(7421-93-4)
o
Concentration
Mass
5.16
Heptachlor
(76-44-8)
Concentration
Mass
5.17
Heptachlor epoxide
(1024-57-3)
Concentration
Mass
5.18
PCB-1242E:i
(53469-21-9)
Concentration
Mass
5.19
PCB-1254
(11097-69-1)
❑
El
❑
Concentration
Mass
5.20
PCB-1221
(11104-28-2)
Concentration
Mass
5.21
PCB-1232
(11141-16-5)
Concentration
Mass
5.22
PCB-1248
(12672-29-6)
Concentration
Mass
5.23
PCB-1260
(11096-82-5)
Concentration
Mass
5.24
PCB-1016
(12674-11-2)El
1:1
El
Concentration
Mass
EPA Form 3510-2C (Revised 3-19) Page 20

EPA Identification Number
110062664255
Facility Name
Former Cates Brinery
uutiall Number
Form Approved 03/05/19
OMB No. 2040-0004
TOXICTABLE B.
1
OTAL PHENOLS,1
ORGANIC
TOXIC'
• I
Intake
Presence or Absence
check one
Effluent
(optional)
Pollutant/Parameter
(and CAS Number, if available)
Testing
Required
Believed
Believed
Units
(specify)
Maximum
Maximum
Long -Term
Average
Number
Long -
Term
Number
Present
Absent
Daily
Discharge
Monthly
Discharge
Daily
Discharge
of
Analyses
Average
of
Analyses
(required)
(if available)
f available
Value
Toxaphene
Concentration
Mass
5.25 (8001-35-2)
i Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C (Revised 3-19) Page 21

This page intentionally left blank.

EPA Identification Number
110062664255
Permit Number Facility Name
Former Cates Brinery
Outfall Number
Form Approved 03/05/19
OMB No. 2040-0004
7mIntake
Presence or Absence
check one
Effluent
(Optional)
['Pollutant
Believed
Believed
Units
(specify)
Maximum Daily
Maximum
Monthly
g•
Lon Term
Average Daily
Number, of
Lon Term
9-
Number of
Present
Absent
Discharge
Discharge
Discharge
Analyses
Average
Value
Analyses
(required)
if available
if available
Check here if you believe all pollutants on Table C to be present in your discharge from the noted outfall. You need not complete the 'Presence or Absence" column of Table C for
❑
each pollutant.
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
El
❑
Concentration
(24959-67-9)
Mass
2
Chlorine, total
❑
❑
Concentration
residual
Mass
3.
Color
El
El
Concentration
Mass
4.
Fecal coliform
❑
ElConcentrationMass
5
Fluoride
❑
❑
Concentration
(16984-48-8)
Mass
6
Nitrate -nitrite
❑
ElConcentration
Mass
7'
Nitrogen, total
❑
❑
Concentration
organic (as N)
Mass
8.
Oil and grease
El
❑
ConcentrationMass
9
Phosphorus (as
❑
❑
Concentration
P), total (7723-14-0)
Mass
10.
Sulfate (as SO4)
❑
❑
Concentration
(14808-79-8)
Mass
F
Sulfide (as S)
❑
❑
Concentration
Mass
EPA Form 3510-2C (Revised 3-19) Page 23

Identification Number I NPDES Permit Number
110062664255
Facility Name
Former Cates Brinery
Form Approved 03/05/19
OMB No. 2040-0004
Intake
Presence or Absence
(check one
Effluent
(Optional)
Believed
Believed
Pollutant
Units
(specify)
Maximum Daily
Maximum
Monthly
Lon Term
g
Average Daily
Number of
Long -Term
Number of
Present
Absent
Discharge
Discharge
Discharge
Analyses
Average
Analyses
(required)
(if available)
if available)Value
12
Sulfite (as S03)
El
Concentration
(14265-45-3)
Mass
13.
Surfactants
El
El
Concentration
Mass
14.
Aluminum, total
Concentration
(7429-905)
Mass
15.
Barium, total
El
Concentration
(7440-39-3)
Mass
16
Boron, total
Concentration
(744042-8)
Mass
17
Cobalt, total
❑
Concentration
(7440-48-4)
Mass
18.
Iron, total
Concentration
(7439-89-6)
Mass
19
Magnesium, total
Concentration
(7439-95-4)
Mass
Molybdenum,
Concentration
20.
total
7439-98-7
Mass
21
Manganese, total
Concentration
(7439-965)
Mass
22
Tin, total
El
Concentration
(7440-31-5)
Mass
23
Titanium, total
Concentration
(744032-6)
Mass
EPA Form 3510-2C (Revised 3-19) Page 24

EPA Identification Nurr
110062664255
Number Facility Name
Former Cates Brinery
uutrau rvumoer
Form Approved 03/05/19
OMB No. 2040-0004
kyj 4 � I N Lei
" F_j W-'l jj:K=
R
Intake
Presence or Absence
check one
7
Effluent
(Optional)
Believed
Believed
Pollutant
Units
(specify)
Maximum Daily
Maximum
Monthly
Long -Term
Average Daily
Number of
Long -Term
Number of
Present
Absent
Discharge
Discharge
Discharge
Analyses
Average
Value
Analyses
(required)
if available
if available
24. Radioactivity
Concentration
Alpha, total
❑
❑
Mass
Beta, total
El
El
Concentration
Mass
Radium, total
El
El
Concentration
Mass
Radium 226, total
❑
ElMass
Concentration
I Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis or pollutants or puuuLdnr pdrdnrClCrs ur
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
1 1 nO62664255 Former Cates Brinery
Number
Form Approved 03/05/19
OMB No. 2040-0004
Reason Pollutant Believed Present in Discharge Available Quantitative Data
(specify units)
Pollutant
Presence or Absence
(check one)
Believed
Present
Believed
Absent
1.
Asbestos
❑
❑
2.
Acetaldehyde
❑
❑
3.
Allyl alcohol
❑
❑
4.
Allyl chloride
❑
❑
5.
Amyl acetate
❑
❑
6.
Aniline
❑
❑
7.
Benzonitrile
❑
❑
8.
Benzyl chloride
❑
❑
9.
Butyl acetate
❑
❑
10.
Butylamine
❑
❑
11.
Caplan
❑
❑
❑
❑
F13.12.Carbaryl
Carbofuran
❑
❑
14.
Carbon disulfide
❑
❑
15.
Chlorpyrifos
❑
El16.
Coumaphos
❑
❑
17.
Cresol
❑
❑
18.
Crotonaldehyde
❑
❑
19.
Cyclohexane
❑
❑
EPA Form 3510-2C (Revised 3-19) Page 27

EPA Identification Number NPDES Permit Number Facility Name ��Ou�IaIlNuml�e,�Form Approved 03/05/19
OMB No. 2040-0004
nnc�ccn��[ Former Cates Brinery
1 :1*2111414
0-
-mom
Reason Pollutant Believed Present in Discharge Available Quantitative Data
(specify units)
F7�•
Pollutant
Presence or Absence
(check one)
Believed
Present
Believed
Absent
20. 2,4-D (2,4-dichlorophenoxyacetic acid)
❑
❑
21.
Diazinon
❑
❑
22.
Dicamba
❑
❑
23.
Dichlobenil
❑
❑
24.
Dichlone
❑
❑
25.
2,2-dichloropropionic acid
❑
❑
26.
Dichlorvos
❑
❑
27.
Diethyl amine
❑
❑
28.
Dimethyl amine
❑
❑
29.
Dintrobenzene
❑
❑
30.
Diquat
❑
❑
31.
Disulfcton
❑
❑
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 0 0-00 4
OMB No. 2040-0004
1 1ontivFr,a?Ss Former Cates Brinery F
1• • i
Reason Pollutant Believed Present in Discharge Available Quantitative Data
(specify units)
Pollutant
Presence or Absence
check one
Believed
Present
Believed
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
❑
❑
Naphthenic acid
❑
F56.
Nitrotoluene
❑
❑
57.
Parathion
❑
❑
EPA Form 3510-2C (Revised 3-19) Page 29

EPA Identification Number
11nnr?rFa755
Facility Name
Former Cates Brinery
Number
Form Approved 03/05/19
OMB No. 2040-0004
14
Presence or Absence
Pollutant check ones_
Believed Believed Reason Pollutant Believed Present in Discharge
r7Present Absent
Available Quantitative Data
(specify units)
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.
TDE (tetrachlorodiphenyl ethane)
❑
❑
70
21415-TP [2-(2,4,5-trichlorophenoxy)
ro anoic acid
❑
❑
71.
Trichlorofon
❑
❑
72.
Triethanolamine
❑
❑
73.
Triethylamine
❑
❑
74.
Trimethylamine
❑
❑
75.
Uranium
❑
❑
76.
Vanadium
❑
❑
EPA Form 3510-2C (Revised 3-19) Page 30

EPA Identification Number NPDES Permit Number T- Facility Name Outfall Number
110062664255 Former Cates Brinery
Form Approved 03/05/19
OMB No. 2040-0004
Presence or Absence
VVVinyll
(check one) Available Quantitative Data
Pollutant Believed BelievedReason Pollutant Believed Present in Discharge (specify units)
Present Absent
ate
78. Xylene El
79. Xylenol El
E8O.Zirconium El
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).
Page 31
EPA Form 3510-2C (Revised 3-19)

This page intentionally left blank.

PDES Permit Number
110062664255
Presence or
TCDD
Absence
Pollutant
Congeners
check one
Believed
Believed
Used or
Manufactured
present
Absent
2,3,7,8-TCDD
❑ 1 ❑ 1 ❑
Facility Name
Former Cates Brinery
Outfall Number
Results of Screening Procedure
Form Approved 03/05/19
OMB No. 2040-0004
EPA Form 3510-2C (Revised 3-19)
Paqe 33