NC0021181_Pretreatment_Annual_Report_20240208

CITY OF BELMONT
PRETREATMENT
ANNUAL
REPORT
2023

City of Belmont
116 N. MAIN STREET I
POST OFFICE BOX 431
BELMONT, N.C. 28012
PHONE [phone]
January 12, 2024
NCDENR
1617 Mail Service Center
Raleigh, NC 27699-1601
Keyes McGee,
Enclosed is a copy of the Annual PAR report for the City of Belmont Wastewater
Treatment Plant for the year 2023. If you have any questions, please contact me at
704-825-3791.
Sincerely,
Ric La Mere
City of Belmont
Pretreatment Coordinator

CITY OF BELMONT
2023 PAR
INDEX
1.) Contact List
2.) Compliance Status Summary & Waste Reduction
3.) Pretreatment Performance Summary
4.) Significant Non -Compliance Report
5.) Spartan Dyers #0009
Industrial Data Form
Data Allocation Table
6.) US Cotton, LLC #0016
7.) Allocation Table
8.) Long Term Monitoring (LTM)
9.) Pretreatment Program Info Database
REPORTING PERIOD: January 1, 2023 TO December 31, 2023

CITY OF BELMONT
PAR 2023
COMPLIANCE SUMMARY AND WASTE REDUCTION
JANUARY 1, 2023 TO DECEMBER 31, 2023
1.SPARTAN DYERS #0009
• Had a malfunctioning keypad on 6/ 12/23 which was replaced promptly
by Clearwater- no NOV sent.
• HEM (oil/grease) sample above permit limit on 7/ 14/23-NOV sent
• Had a malfunctioning PH probe on 10/ 11/2023 which was replaced and
calibrated promptly- no NOV sent.
2. US Cotton, LLC #0016
• US Cotton was issued a permit on 3/5/2021 but they have not yet gone
into operation as of Dec. 31, 2023.
Our pretreatment program is currently working with only two SIU's for the year
2023. All SIU's will continue to follow our program and improve on all aspects
of compliance.
3. Reports :
• HWA-due 5/ l/2021- sent on 4/29/2021
• LTMP-approved 6/26/2020
• IWS-approved 10/12/2020
Sincerely,
Ric La Mere
City of Belmont
Pretreatment Coordinator

Chapter 9, PAR Guidance
Pretreatment Performance Summary (PPS)
1. Pretreatment Town Name: City of Belmont
2. "Primary" NPDES Number NC00 21181
or Non Discharge Permit # if applicable =>
3.
PAR Begin Date, please enter 01/01/yyyy
3. _>
l/l/2023
4.
PAR End Date, please enter 12/31/yyyy
4. =>
12/31/2023
5.
Total number of SIUs, includes CIUs
5. =>
2
6.
Number of CI Js
6. =>
0
7.
Number of SNs with no NP, or with an expired NP
7. _>
0
8.
NLu tber of SNs not inspected by POTW
8. =>
0
9.
Number of SNs not sampled by POTW
9. _>
0
10.
Number of SNs in SNC due to IUP Limit violations
10. _>
0
it.
Number of SNs in SNC due to Reporting violations
11. _>
0
12.
Number of SNs in SNC due to violation of a Compliance Schedule, CO, AO or similar
12. _>
0
13.
Number of CIUs in SNC
13. _>
0
14.
Number of SNs included in Public Notice
14. =>
0
15
Total number of SNs on a compliance schedule, CO, AO or similar
15. =>
0
16.
Number ofNOVs, NNCs or similar assesed to SNs
16. _>
1
17.
Number of Civil Penalties assessed to SNs
17. _>
0
18.
Number of Criminal Penalties assessed to SIUs
18. =>
0
19.
Total Amount of Civil Penalties Collected 19. =>
$
0
20.
Number of IUs from which penalties collected
20. _>
0
,Totes:
AO Administrative Order RIP Industrial User Pretreatment Permit POTW
CIU Categorical Industrial User NNC Notice of Non -Compliance SIU
Publicly Owned Treatment Works
Significant Industrial User
CO Consent Order NOV Notice of Violation SNC
Significant
Non -Compliance
IU Industrial User PAR Pretreatment Annual Report
revised l/2018: PAR PPS 2018

Pretreatment Annual Report (PAR)
Significant Non -Compliance Report (SNCR)
WWTP = Wastewater Treatment Plant, use separate form for each WWTP.
SIU = Significant Industrial User
SNC = Significant Non -Compliance
PAR covers this calendar year => Jan. 2023-Dee. 2023
Control Authority=Program=Town Name => City of Belmont
WWTP Name =>
NPDES # _>
A SNCR Form must be submitted with every PAR, please write "None " if you had No SIUs in SNC during calendar year
IUP
#
Pipe
#
Industry Name
Parameter
or "Reporting"
SNC? ( Yes / No )
for each 6-month period.
Jan. - June
July - Dec.
0009
001
Spartan Dyers
None
NO
NO
16
1
US Cotton, LLC.
None
NO
NO
Attach a copy of the Division's "SIUs in SNC Historical Report" for your POTW's SIUs behind this page.
Is the database correct ? Notify the Division of any errors ! Database indicates SNC history for previous years.
EVERY SNC MUST be explained in the Narrative, How was, is, or will it be resolved?
REPEAT SNCs are serious matters that MUST be explained in the Narrative.
Form name: PAP SNCR,2001
Date Revised: 1/4/2001
Belmont WWTP
NC 0021181

SPARTAN DYERS
#0009
JANUARY 1, 2023 TO DECEMBER 31, 2023

Pretreatment Annual Report (PAR) Control Authority, Industry
Industrial Data Summary Form (IDSF) Town Name => City of Belmont Name Spartan Dyers
n Form
pipe WWTP Name => Belmont W WTh "# 0009
Use separate forms for each
ENPDES # _> N C0021181 Pipe # 001
Enter BDL values as < (value)
1st 6 months, dates => Jan. 12023 to Jun. 30 2023
2nd 6 months, dates => Jul. 12023 to Dec. 312023
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) =>
* or Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations,(chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) _>
* or Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) =>
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or Average (mg/1) =>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) =>
ow, mg
mmoma
st b months 12ncl
0 monnis
lst6monttis
j2nd6montliS
At6mcmthS
2nc[6montlis
lst6montlis
Znc[Omontlis
187
190
6
6
6
6
6
6
0.4085
0.449
21
26
73
110
1.1
0.37
0.0915
0.1184
15.33
13
48.3333
56
0.36
0.22
0%
0%
0%
0%
0%
0%
N/A
N/A
0%
1 0%
1
0%
0%
i
0%
0%
N/A
N/A
rsmmen
Cadmium
rommmUOU
st
m
n
mon s
st
mo
st
mon s
2nd
6 montlis
6
6
6
6
6
6
6
6
0.05
0.01
0.0065
0.013
0.065
0.0125
260
280
0.0138
0.032
0.0016
0.004
0.0163
0.0042
164.67
175.3333
N/A
N/A
N/A
N/A
N/A
N/A
0%
0%
N/A
I N/A
N/A
N/A
N/A
N/A
1
0%
0%
opper
Uyanule
IlLead
I
ereury
st mon s
n months
st
months
2nd 6
mont s
I st 6
months
2nd 6
months
I st 6
montlis
2nd
6 months
6
6
6
6
6
6
2
2
0.16
0.13
0.005
0.005
0.025
0.005
0
0
0.105
0.08
0.005
0.005
0.0066
0.002
0
0
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
BDL => Below Detection Limit mg/I => milligrams per liter
' POTW must enter at least one of these IUP => Industrial User Permit lb/d => pounds per day
four rows, Please indicate how averages were calculated SNC => Significant Non -Compliance mgd => million gallons per day
Avg period could be month, Qtr, or 6-month & if BDL, 1/2BDL, or zero values used. TRC => Technical Review Criteria W WTP => wastewater treatment plant
Chapter: PAR Guidance File name: PFILdL�&dh�Redigiirk¢a�t�,ctRBAB, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page of

Pretreatment Annual Report (PAR)
Industrial Data Summary Form (IDSF)
Use separate forms for each industry/pipe
Enter BDL values as < (value)
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) =>
* or Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (Ib/d) =>
* or Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or Average (mg/1) _>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) _>
Industry Name
IUP #
Pipe #
r
r
t � •
rr>i��at�tz�t�rs>tlx�
��.
.. �r�srrarralsl�
.�
r.1lrrrsma�
..
rusrrsrrsslix�
rrrr.
..
�rsrarraal�rrrrssT.rv��
....
n�srr.
�. �
..
rr3rrrnnsx�nnrrrsrassa�
BDL => Below Detection Limit mg/I => milligrams per liter
* POTW must enter at least one of these RIP => Industrial User Permit Ib/d => pounds per day
four rows, Please indicate how averages were calculated SNC => Significant Non -Compliance mgd => million gallons per day
Avg period could be month, Qtr, or 6-month & if BDL, 1/2BDL, or zero values used. TRC => Technical Review Criteria W WTP => wastewater treatment plant
Chapter: PAR Guidance File name: pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page of

Pretreatment Annual Report (PAR)
Industrial Data Summary Form (IDSF)
Use separate forms for each industry/pipe
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum =>
* or Minimum =>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Industry Name Spartan Dyers
IUP # 0009
Pipe # 001
tc
e
e enm
t ver
o yvmon en
s
mon s
n
mon s
s mon s
n
mon s
s
mon s
n
mon s
s
s
n
mon s
6
6
6
6
6
6
6
6
0.039
0.013
0.065
0.0125
0.0125
0.0025
0.125
0.025
0.014
0.007
0.0207
0.0095
0.0033
0.0008
0.033
0.008
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
p
empera ure
st
mon s
n
mon s
st6 mon s
2nd. 6
months
Ist 6
months
2nd 6
months
I st 6
mon s
n
mont T
187
190
187
190
8.3
8.1
25.4
31.3
7.1
7.8
16.4
18
N/A
N/A
N/A
I
N/A
st 6
months
2nd6montlis
Ist6months
2nd6monttis
st
mon s
n
mon s
st
months
n
months
BDL => Below Detection Limit mg/1=> milligrams per liter
* POTW must enter at least one of these 1UP => Industrial User Permit lb/d —> pounds per day
four rows, Please indicate how averages were calculated SNC => Significant Non -Compliance mgd => million gallons per day
Avg period could be month, Qtr, or 6-month & if BDL , 1/2BDL, or zero values used. TRC —> Technical Review Criteria W WTP => wastewater treatment plant
Chapter: PAR Guidance File name: *cIWB, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page of

Pretreatment Annual Report (PAR) Industry Name
Industrial Data Summary Form (IDSF) Np #
Use separate forms for each industry/pipe Pipe #
Enter BDL values as < (value)
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) _>
* or Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) =>
��sr�mssl�r�srrsanslsl���srsarass��rrrrrT.ns����r�rralsl�r�srrsssrastia�
rrrrirrassl�
f�r�nsrsl�r�rslrml���r.-srml�rnrrs�ssss�sx�
.�
r�srrrsrnrasx���srsssms��rrrrs�sursl�
��rssmisl�rrrresasssslx�
rrrrrsslslix�
. ��.�
rrrr.�rsrrs�sx���r.�rralsa�r.�rrsarsl�
BDL => Below Detection Limit mg/I => milligrams per liter
* POTW must enter at least one of these IUP => Industrial User Permit lb/d => pounds per day
four rows, Please indicate how averages were calculated SNC => Significant Non -Compliance mgd => million gallons per day
Avg period could be month, Qtr, or 6-month & if BDL, 1/2BDL, or zero values used. TRC => Technical Review Criteria W WTP => wastewater treatment plant
Chapter: PAR Guidance File name: *cIWB, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page of

US Cotton, LLC.
#0016
JANUARY 1, 2023 TO DECEMBER 31, 2023

US Cotton, LLC.
** We do not have any SIU Data Summary or IDSF for US
Cotton because they have not started operations as of Dec. 31,
2023

POTw=;
NPDFS#=
IUP
Count
1
2
3
4
5
6
7
8
9
10
Allocation Table
Spreadsheet Instructions:
1) Applicable Values should be entered in the Heavy Bordered cells. Rest of worksheet is protected, password is"P".
2) Formulas are discussed in the Comprehensive Guidance, Chapter 6, Section C.
3) HWA and AT worksheets in this workbook are linked. Pollutant Names, MAHLs, Basis, and Uncontrollable load in this AT worksheet are
automatically entered from the HWA spreadsheet. This includes pollutant names in columns AT through BK.
Headworks last approved:
Allocation Table updated:
Permits last modified:
8/24/16
2/10/27
Belmont WWTP
11/5/19
NC 0021181
Type Original Modification Date
of Effective Effective Permit
Industry Date Date Expires
FLOW
Permit Limits
BOD
Permit Limits
TSS
Permit Limits
Ammonia
Permit Limits
Arsenic
Pennit Limits
Industry
INDUSTRY NAMES Permit/Pipe
(please fiat slph bedcly) number
MGD val/dav
Cone. Load
m 1 Ibs/day
300.00 2251.80
Cone. Load
mg/1 lbs/da
250.00 1876.501
Cone. Load
mg/1 lbs/day
monitor
Conc. Load
I m l lbs/day
monitor
Spartan Dyers
009/001
textile 1
11/5/2019
11/7/2012
11/5/20241
0.9000
900,0001
US Cotton
0016/001
textile
3/12/2021
3/11/2026
0.0400
40,0001
250.00
83.40
250.00
83.40
monitor
monitor
Column Totals =>
0.9400
940,000
2335.20
1959.90
0.00
0.0000
Basis=>
MAUL from HWA (lbs/day) _>
Uncontrollable Loading (lbs/day) _>
Total Allowable for Industry (lbs/day) _>
Total Permitted to Industry (lbs/day) _>
Allowable loading left (lbs/day) _>
Percent Allow. Ind. still available (%o) _>
Percent MAUL still available (%) _>
5 Percent MAUL (lbs/day) _>
NPDES Permitted Flow=>
5.0000
10425.00
10425.00
834.00
0.1617
1.0938
1724.00
2769.00
141.79
0.0038
3.9062
8701.00
7656.00
692.21
0.1579
0.9400
2335.20
1959.90
0.00
0.0000
2.9662
6365.80
5696.10
692.21
0.1579
75.9%
73.2%
74.4%
100.0%
100.0%
59.3 %
r 61.1 %
54.6 /
521
41.

Cadmium
Permit Limits
Cone. Load
m 1 Ibs/day
monitor
monitor
Chromium
Permit Limits
Conc. Load
mg/1 lbs/da
monitor
monitor
Copper
Permit Limits
Conc. Load
mg/1 lbs/day
0.2500 1.8765
0.2500 0.0834
Cyanide
Permit Limits
Cone. Load
mg/1 lbs/da
monitor
monitor
Lead
Permit Limits
Cone. Load
mg/I lbs/day
monitormonitor
monitor
Mercury
Permit Limits
Cone. Load
mg/1 lbs/day
monitor
Molybdenum
Pennit Limits
Cone. Load
m 1 lbs/day
monitor
monitor
Nickel
Permit Limits
Conc. Load
m 1 lbs/da
monitormonito
monitor
Selenium
Permit Limits
Cone. Load
mg/1 lbs/day
monitor
Silver
Permit Limits
Conc. Load
m 1 lbs/da
monitor
monitor
0.0000
0.0000
1 1.95991
0.0000
1 0.0000
0.00000
0.0000
0.0000 0.0000 0.0000
0.1231
4.3703
5.3243
1.1092
1.3357
0.0019
0.0374
0.4886
0.0460
0.0134
0.1212
4.3329
4.8357
1.0632
1.3223
0.0000
0.0000
0.0000
0.0000
0.0000
0.1212
4.3329
4.8357
1.0632
1.3223
100.0 %
100.0 %
100.0 %
100.0 %
100.0 %
98.5 %
99.1
r 90.8 %
r 95.9 %
99.0
0.01569
0.2205
0.9700
0.1940
0.00249
0.0335
0.0220
0.0000
0.01320
0.1870
0.9480
0.1940
0.00000
0.0000
0.0000
0.0000
0.01320
0.1870
0.9480
0.1940
100.0 %
100.0 %
100.0 %
100.0
84.1 %
84.8 %
97.7%1
100.0 %
0.0555 r 0.06681 1 0.000781 0.01
2.7731
1 2.77311

Zinc
Permit Limits
Oil & Grease
Permit Limits
Chlorides
Permit Limits
Total Phosphorus
Permit Limits
COD
Permit Limits
e
Permit Limits
f
Permit Limits
g
Permit Limits
h
Permit Limits
I
Permit Limits
Cone. Load
mg/1 lbs/da
Cone. Load
m I Ibs/day
Cone. Load
mg/1 lbs/da
Cone. Load
m I lbs/da
Cone. Load
mg/1 lbs/day
Cone. Load
mg/I lbs/day
Cone. Load
mg/1 lbs/day
Colic. Load
mg/1 lbs/day
Cone. Load
mg/1 lbs/day
Colic. Load
mg/1 lbs/day
monitor
50.0000
375.3000
monitor
monitor
500.0000
3753.0000
monitor
50.0000
16.6800
monitor
monitor
500.0000
166.8000
its
0.0000
391.9800
0.0000
0.0000
3919.8000

Pretreatment. Program Info Database
for Program Name Belmont
WWTP Name City of Belmont
printed on: 1 /10/2024
am information _ ' IWC % at 7Q10 7.53
Program Approval Date 10/21/1983
Pretreatment Status
Full
Region
MRO
County
Gaston
NPDES Number
NCO021181
70`T0-Flow cfs / mgd 95 / 61.37
1 Q10 Flow cfs / mgd 77.57 / 50.14
Stream Classification WS-IV & B-CA
Basin Number CTB34
Receiving Stream Name CATAWBA RIVER
NPDES Effective Date 12/01/2019 Last PAR Rec 02/16/2022 PAR Due Date03/01/2023 mercury
Current Fiscal 1631
NPDES Expire Date 06/30/2024 Year PCI Done 12/16/2021 required
POTW is Primary WWTP TRUE Last Audit on 11/06/2019 Audit Year Nex123/24 yes
Design Flow mgd 5.0000 ova Design mgd is SIU permitted 26.00 Permitted SIU flow (mgd) [Pt SIU) 1.3
WWTP SIU's 2 Program SIUs 2 w _
KK
WWTP CIU's 1 Program CIUs 1 HWAROLM
LIMP IWS SUO r,., .; y
date Inactive Date Next Due
Date Received by DWR 04/29/2021 01/18/2019 07/08/2020 05/20/2013 11/05/2019
Date Approved I�� 02/26/2019 10/12/2020 05/28/2013J 02/05/2020
Adopt Date Required
Date Adopted 05/06/2013J
Info in this Box from Pt Contacts Date Date Date_
PT_Pro Attended Attended Attended
Formal Name o.Prime Phone1 ext Fax W WA IAM. .
Ms. Tanya Setzer Carter
1 11704-901-2085
04-825-6505
[e-mail] JWWTPORC
IPO
Box 431 IP8012
Mr. Rick La Mere
jPrim
[phone]
[e-mail]
Ptetreatmebt Coordinator
PO Box 431
28012
3/15/2006
14
enforcement, Itmp
ailed to take enforcement per ERP
014-PC-0267, Failure to issue IUP
016-PC-0239. Failure to enforce, s
DWR Central Office Contact JPretreatment Staff
DWR Regional Contact es Bell

Pretreatment Annual Report (PAR)
Industrial Data Summary Form (IDSF)
Use separate forms for each industry/pipe
Enter BDL values as < (value)
Total # of samples =>
Maximum (mg/1) =>
or M axi mum (1 b/d) =>
or Average(mg/1) =>
or Average Loading (I b/d) =>
% viol ations,(chronic SNC is>= 66%) =>
% TRC violations, (SNC is>= 33 %) =>
Total # of samples =>
Maximum (mg/1) =>
or Maximum (lb/d) =>
or Average(mg/1) =>
or Average Loading (I b/d) =>
% violations, (chronic SNC is>= 66%) =>
% TRC violations, (SNC is>= 33 %) =>
Total # of samples =>
Maximum (mg/1) =>
or Maximum (lb/d) =>
or Average (mg/1) =>
or Average Loadi ng (I b/d) =>
% violations, (chronic SNC is>= 66%) =>
% TRC violations, (SNC is>= 33 %) =>
Control Authority,
Town Name=> City of Belmont
W WT P Name => Belmont W WIP
N PD ES # => N C0021181
1st 6 months, dates => Jan. 1 2023 to Jun. 30 2023
2nd 6 months, dates => Jul. 12023 to Dec. 312023
I industry
Name Spartan Dyers
I u P # 0009
Pipe # 001
months
n months
mon s
n mon s
mon s
n mon s
mon s
2nd 6 months
187
190
6
6
6
6
6
6
0.4085
0.449
21
26
73
110
1.1
0.37
0.0915
0.1184
15.33
13
48.3333
56
0.36
0.22
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
rsenlc
Marrilurn
unrorrilurn
1st 6 months
2nd 6 months
2nd 6 months
1st 6 months
2nd 6 months
6
6
6
6
6
6
6
6
0.05
0.01
0.0065
0.013
0.065
0.0125
260
280
0.0138
0.032
0.0016
0.004
0.0163
0.0042
164.67
175.3333
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Copper �
Cyani
y
1st 6 months
2nd 6 months
st mont s
2nd 6 months
st mont s
2nd 6 months
st mont s
2nd 6 months
6
6
6
6
6
6
2
2
0.16
0.13
0.005
0.005
0.025
0.005
0
0
0.105
0.08
0.005
0.005
0.0066
0.002
0
0
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
BDL => Below Detection Limit mg/I => milligrams per liter
POTW must enter at least one of these IUP=> Industrial User Permit Ib/d => pounds per day
fourrows, Rease indicate how averages were calculated SNC => Significant Non -Compliance mgd => million gallons per day
Avg period could be month, Qtr, or 6-month & if BDL , 1/2BDL, or zero values used. TRC => Technical Review Criteria WWTP=> wastewater treatment plant
Chapter: PAR Guidance File name: PPlEbiii�islde�i'�uJa�teli$tc1iIB, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe- Page of

Pretreatment Annual Report (PAR)
Industrial Data Summary Form (IDSF)
Use separate forms for each industry/pipe
Enter BDL values as < (value)
Total # of samples =>
Maximum (mg/1) _>
or Maximum (I b/d) _>
or Average(mg/1) _>
or Average Loading (I b/d) _>
% violations, (chronic SNC is>= 66%) _>
%TRC violations, (SNC is>= 33 %) _>
Total # of samples =>
Maximum (mg/1) _>
or Maximum (lb/d) _>
or Average(mg/1) _>
or Average Loading (I b/d) _>
% violations, (chronic SNC is>= 66%) _>
% TRC violations, (SNC is>= 33 %) _>
Total # of samples =>
Maximum (mg/1) _>
or Maximum (lb/d) _>
or Average(mg/1) _>
or Average Loading (I b/d) _>
% violations, (chronic SNC is>= 66%) _>
% TRC violations, (SNC is>= 33 %) _>
Industry Name
IUP#
Pipe #
inc
i se
us
1st months
n months
st mont s
n months7m7ontos
n mont s
st mont s
n mont s
6
6
6
6
6
6
6
6
0.75
0.85
5.1
150100
1100
3
2.7
0.45
0.5
2.93
28.38
738.33
815
2.28
2.27
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
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• W[.^TiT.TiM • W[.^TiT.TiM • W[.^TiT.TiM • W[.^TiT.TiM
BDL => Below Detection Limit mg/I => milligrams per liter
POTW must enter at least one of these IUP=> Industrial User Permit Ib/d => pounds per day
four rows, R ease indicate how averages were calculated SNC => Significant Non -Compliance mgd => mi I I i on gal I ons per day
Avg period could be month, Qtr, or 6-month & if BDL , 1/2BDL, or zero values used. TRC => Technical Review Criteria WWTP=> wastewater treatment
Chapter: PAR Guidance File name: PPlEbiii�isldJ�ia�teli$tc1iIB, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe- Page of

Pretreatment Annual Report (PAR)
Industrial Data Summary Form (IDSF)
Use separate forms for each industry/pipe
Total # of samples =>
Maximum (mg/1) _>
or M axi mum (1 b/d) _>
or Average(mg/1) _>
or Average Loading (I b/d) _>
% violations, (chronic SNC is>= 66%) _>
% TRC violations, (SNC is>= 33 %) _>
Total # of samples =>
Maximum =>
or Minimum =>
% violations, (chronic SNC is>= 66%) _>
% TRC violations, (SNC is>= 33 %) _>
Total # of samples =>
Maximum (mg/1) _>
or Maximum (lb/d) _>
or Average(mg/1) _>
or Average Loading (I b/d) _>
% violations, (chronic SNC is>= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
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BDL => Below Detection Limit mg/I => milligrams per liter
POTW must enter at least one of these IUP=> Industrial User Permit Ib/d => pounds per day
fourrows, Rease indicate how averages were calculated SNC => Significant Non -Compliance mgd => million gallons per day
Avg period could be month, Qtr, or 6-month & if BDL , 1/2BDL, or zero values used. TRC => Technical Review Criteria WWTP=> wastewater treatment plant
Chapter: PAR Guidance File name: PPlEbiii�islde�i'�uJa�teli$tc1iIB, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe- Page of

Pretreatment Annual Report (PAR)
Industry Name
Industrial Data Summary Form (IDSF) IUP #
Use separate forms for each industry/pipe Pipe #
Enter BDL values as < (value)
Total # of samples =>
Maximum (mg/1) =>
or M axi mum (I b/d) =>
or Average (mg/1) =>
or Average Loadi ng (I b/d) =>
% violations, (chronic SNC is>= 66%) =>
% TRC violations, (SNC is>= 33 %) =>
Total # of samples =>
Maximum (mg/1) =>
or M axi mum (I b/d) =>
or Average (mg/1) =>
or Average Loadi ng (I b/d) =>
% violations, (chronic SNC is>= 66%) =>
% TRC violations, (SNC is>= 33 %) =>
Total # of samples =>
Maximum (mg/1) =>
or M axi mum (I b/d) =>
or Average (mg/1) =>
or Average Loadi ng (I b/d) =>
% violations, (chronic SNC is>= 66%) =>
% TRC violations, (SNC is>= 33 %) =>
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POTW must enter at least one of these IUP=> Industrial User Permit Ib/d => pounds per day
fourrows, Please indicate how averages were calculated SNC => Significant Non -Compliance mgd => million gallons per day
Avg period could be month, Qtr, or 6-month & if BDL , 1/2BDL, or zero values used. TRC => Technical Review Criteria WWTP=> wastewater treatment plant
Chapter: PAR Guidance File name: pages 12, 13,14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe- Page of