NC0036773_Renewal (Application)_20240222

o,f,STATE o•A�
�a MAY. n]
ROY COOPER �,,
Governor ,p -
ELIZABETH S.BISER ''����^ � I
Secretary : � N•0-'
RICHARD E.ROGERS,JR. NORTH CAROLINA
Director Environmental Quality
February 22, 2024
City of Laurinburg
Attn: Dixon Medlin
PO Box 249
Laurinburg, NC 28353
Subject: Permit Renewal
Application No. NC0036773
Laurinburg WTP
Scotland County
Dear Applicant:
The Water Quality Permitting Section acknowledges the February 22, 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. 150B-3 your current permit does not expire until permit decision on the application is made.
Continuation of the current permit is contingent on timely and sufficient application for renewal of the current permit. The
permit writer will contact you if additional information is required to complete your permit renewal. Please respond in a
timely manner to requests for additional information necessary to allow a complete review of the application and renewal
of the permit.
Information regarding the status of your renewal application can be found online using the Department of Environmental
Quality's Environmental Application Tracker at:
https://deq.nc.gov/permits-regulations/permit-guidance/environmental-application-tracker
If you have any additional questions about the permit, please contact the primary reviewer of the application using the
links available within the Application Tracker.
5Sincerire„
.it •Nit aro!
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application
C_. E North Carolina Department of Environmental Quality I Division of Water Resources
,:
�/ Fayetteville Regional Office 225 Green Street.Suite 7I4 Fayetteville.North Carolina 28301
�� / 910.433.3300

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0036773 Laurinburg WTP OMB No.2040-0004
Form U.S.Environmental Protection Agency
1 \-/EPA Application for NPDES Permit to Discharge Wastewater
NPDES GENERAL INFORMATION
SECTION 1.ACTIVITIES REQUIRING AN NPDES PERMIT(40 CFR 122.21(f)and(f)(1))
1.1 Applicants Not Required to Submit Form 1
Is the facility a new or existing publicly owned Is the facility a new or existing treatment works
1.1.1 2
treatment works? 1.1. treating domestic sewage?
If yes,STOP. Do NOT complete 0 No If yes,STOP.Do NOT ✓g 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?
oElYes 4 Complete Form 1 0 No ❑ Yes 4 Complete Form ID No
and Form 2B. 1 and Form 2C.
1.2.3 Is the facility a new manufacturing,commercial, 1.2.4 Is the facility a new or existing manufacturing,
mining,or silvicultural facility that has not yet commercial,mining,or silvicultural facility that
commenced to discharge? discharges only nonprocess wastewater?
Yes 4 Complete Form 1 El No ❑ Yes 4 Complet pfiv 0 No
cc and Form 2D. ECe l2
1.2.5 Is the facility a new or existing facility whose 61 v
discharge is composed entirely of stormwater 2 2-0-4 associated with industrial activity or whose 2
discharge is composed of both stormwater and S
non-stormwater? � top E
❑ Yes 4 Complete Form 1 0 No NCOEQ,
and Form 2F
unless exempted by
40 CFR
122.26(b)(14)(x)or
b 15 .
SECTION 2.NAME, MAILING ADDRESS,AND LOCATION(40 CFR 122.21(f)(2))
2.1 Facility Name
Laurinburg WTP
0 2.2 EPA Identification Number
U
0
'a
co 2.3 Facility Contact
C.) Name(first and last) Title Phone number
Dixon Medlin Water Treatment Director 1(910)291-1716
c Email address
[e-mail]
6- 2.4 Facility Mailing Address
Street or P.O.box
PO Box249
City or town State ZIP code
Laurinburg NC 28352
EPA Form 3510-1(revised 3-19) Page 1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0036773 Laurinburg WTP OMB No.2040-0004
H g 2.5 Facility Location
.� : Street,route number,or other specific identifier
Q v 603 Lauchwood Dr.
,
c a County name County code(if known)
1-4 Scotland
City or town State ZIP code
g Laurinburg NC 28352
SECTION 3.SIC AND NAICS CODES(40 CFR 122.21(f)(3))
3.1 SIC Code(s) Description(optional)
U,
.d
O
N
3 2 NAICS Code(s) Description(optional)
SECTION 4.OPERATOR INFORMATION(40 CFR 122.21(f)(4))
4.1 Name of Operator
Dixon Medlin
0 4.2 Is the name you listed in Item 4.1 also the owner?
❑ Yes No
4.3 Operator Status
R ❑ Public—federal C3 Public—state ❑ Other public(specify)
0 ❑ Private ❑ Other(specify)
4.4 Phone Number of Operator
[phone]
4.5 Operator Address
Street or P.O. Box
PO Box 249
o
.c City or town State ZIP code
•O v Laurinburg NC 28352
O. Email address of operator
0 [e-mail]
SECTION 5.INDIAN LAND(40 CFR 122.21(f)(5))
a 0 5.1 Is the facility located on Indian Land?
C ' ❑Yes 2 No
EPA Form 3510-1(revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0036773 Laurinburg WTP OMB No.2040-0004
SECTION 6.EXISTING ENVIRONMENTAL PERMITS(40 CFR 122.21(f)(6))
6.1 Existing Environmental Permits(check all that apply and print or type the corresponding permit number for each)
❑✓ NPDES(discharges to surface ❑ RCRA(hazardous wastes) ❑ UIC(underground injection of
c N water) fluids)
W ri ❑ PSD(air emissions) ❑ Nonattainment program(CM) ❑ NESHAPs(CM)
rn
w
El Ocean dumping(MPRSA) El Dredge or fill(CWA Section 404) CI Other(specify)
SECTION 7. MAP(40 CFR 122.21(f)(7))
7.1 Have you attached a topographic map containing all required information to this application?(See instructions for
ma- specific requirements.)
r❑Yes ❑ No ❑ CAFO—Not Applicable(See requirements in Form 2B.)
SECTION 8. NATURE OF BUSINESS(40 CFR 122.21(f)(8))
8.1 Describe the nature of your business.
Renewal permit application for permit number NC0036773-Laurinburg WTP/Media Backwash water from filters.
Waste generated-
c—, WTP-Permitted design 8 MGD. Groundwater treatment.Ph adjustment(Sodium Hydroxide),Flouride(Hydrofluoric
m acid)Chlorine(Sodium Hypochlorite),Aeration,Rention Basin.Sand filtration,Post filter Ph/Chlorine adjustment.
i R �
Z i
SECTION 9.COOLING WATER INTAKE STRUCTURES(40 CFR 122.21(f)(9))
9.1 Does your facility use cooling water?
❑ Yes ❑ No 4 SKIP to Item 10.1.
9.2 Identify the source of cooling water.(Note that facilities that use a cooling water intake structure as described at
a,w 40 CFR 125,Subparts I and J may have additional application requirements at 40 CFR 122.21(r).Consult with your
•o �; NPDES permitting authority to determine what specific information needs to be submitted and when.)
O Y
C
SECTION 10.VARIANCE REQUESTS(40 CFR 122.21(f)(10))
10.1 Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(m)?(Check all that
apply.Consult with your NPDES permitting authority to determine what information needs to be submitted and
5 when.)
d ❑ Fundamentally different factors(CWA ❑ Water quality related effluent limitations(CWA Section
ce Section 301(n)) 302(b)(2))
❑ Non-conventional pollutants(CWA ❑ Thermal discharges(CWA Section 316(a))
co Section 301(c)and(g))
Not applicable
EPA Form 3510-1(revised 3-19) Page 3

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0036773 Laurinburg WTP OMB No.2040-0004
SECTION 11.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d))
11.1 In Column 1 below,mark the sections of Form 1 that you have completed and are submitting with your application.
For each section,specify in Column 2 any attachments that you are enclosing to alert the permitting authority.Note
that not all applicants are required to provide attachments.
Column 1 Column 2
El Section 1:Activities Requiring an NPDES Permit ❑ w/attachments
❑✓ Section 2:Name,Mailing Address,and Location ❑ w/attachments
❑ Section 3:SIC Codes ❑ wl attachments
El Section 4:Operator Information ❑ w/attachments
❑ Section 5:Indian Land ❑ w/attachments
❑ Section 6: Existing Environmental Permits ❑ w/attachments
Section 7:Map w/topographic
map ❑
0 w/additional attachments
o El Section 8:Nature of Business ❑ wl attachments
❑ Section 9:Cooling Water Intake Structures ❑ wl attachments
❑ Section 10:Variance Requests ❑ wl attachments
0 Section 11:Checklist and Certification Statement ❑ w/attachments
11.2 Certification Statement
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision
in accordance with a system designed to assure that qualified personnel properly gather and evaluate the
information submitted.Based on my inquiry of the person or persons who manage the system,or those persons
directly responsible for gathering the information, the information submitted is,to the best of my knowledge and
belief, true,accurate,and complete.I am aware that there are significant penalties for submitting false information,
including the possibility of fine and imprisonment for knowing violations.
Name(print or type first and last name) Official title
Dixon Medlin Water Treatment Director
Signature Date signed
c'D 0140 .
z / 3/Zq
EPA Form 3510-1(revised 3-19) Page 4

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BACK WASH Totals for 2023
0.056129 JAN
0.058964 FEB
0.058097 MAR
0.0595 APR
0.062903 MAY
0.0565 JUNE
0.051774 JULY
0.054 AUG
0.060433 SEPT
0.065871 OCT
0.057367 NOV
0.062355 DEC
0.703893 TOTAL
0.06 AVG

•
EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0036773 Laurinburg WTP OMB No.2040-0004
Form U.S.Environmental Protection Agency
2C \—/EPA Application for NPDES Permit to Discharge Wastewater
NPDES EXISTING MANUFACTURING,COMMERCIAL,MINING,AND SILVICULTURE OPERATIONS
SECTION 1.OUTFALL LOCATION(40 CFR 122.21(g)(1))
1.1 Provide information on each of the facility's outfalls in the table below.
Outfa
o Number Receiving Water Name Latitude Longitude
001 Big Branch 34° 75' 14' N -79° 46' SSA W E
co
0
SECTION 2.LINE DRAWING(40 CFR 122.21(g)(2))
Q, 2.1 Have you attached a line drawing to this application that shows the water flow through your facility with a water
c balance?(See instructions for drawing requirements.See Exhibit 2C-1 at end of instructions for example.)
L
El Yes ❑ No
SECTION 3.AVERAGE FLOWS AND TREATMENT(40 CFR 122.21(g)(3))
3.1 For each outfall identified under Item 1.1,provide average flow and treatment information.Add additional sheets if
necessary.
**Outfall Number** 001
Operations Contributing to Flow
Operation Average Flow
Media filter-backwash .006 mgd
c
mgd
E` mgd
mgd
°W Treatment Units
Description Code from Final Disposal of Solid or
fti
(include size,flow rate through each treatment unit, Table 2C-1 Liquid Wastes Other Than
retention time,etc.) by Discharge
Permitted 8mg Water Treatment Facility Js are mixed with solids from W%
RECEwED
v a 2,2 2024
N
CDEQION`in' DES
EPA Form 3510-2C(Revised 3-19) Page 1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0036773 Laurinburg WTP OMB No.2040-0004
3.1 **Outfall Number**
cont. Operations Contributing to Flow
Operation Average Flow
mgd
mgd
mgd
mgd
Treatment Units
Description Code from Final Disposal of Solid or
(include size,flow rate through each treatment unit, Table 2C-1 Liquid Wastes Other Than
retention time,etc.) by Discharge
7-2
0
U
m
E
**Outfall Number**
Operations Contributing to Flow
o Operation Average Flow
rn mgd
' mgd
mgd
mgd
Treatment Units
Description Code from Final Disposal of Solid or
(include size,flow rate through each treatment unit, Table 2C-1 Liquid Wastes Other Than
retention time,etc.) by Discharge
3.2 Are you applying for an NPDES permit to operate a privately owned treatment works?
❑ Yes ElNo 4 SKIP to Section 4.
cn= 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
NC0036773 Laurinburg WTP OMB No.2040-0004
SECTION 4.INTERMITTENT FLOWS(40 CFR 122.21(g)(4))
4.1 Except for storm runoff,leaks,or spills,are any discharges described in Sections 1 and 3 intermittent or seasonal?
❑ Yes 0 No 3 SKIP to Section 5.
4.2 Provide information on intermittent or seasonal flows for each applicable outfall.Attach additional pages,if necessary.
Outfall Operation Frequency Flow Rate
Number (list) Average Average Long-Term Maximum Duration
DayslWeek Months/Year Average Daily
days/week months/year mgd mgd days
N
o days/week months/year mgd mgd days
u-
m days/week months/year mgd mgd days
P
E days/week months/year mgd mgd days
c
days/week months/year mgd mgd days
days/week months/year mgd mgd days
days/week months/year mgd mgd days
days/week months/year mgd mgd days
days/week months/year mgd mgd days
SECTION 5.PRODUCTION(40 CFR 122.21(g)(5))
5.1 Do any effluent limitation guidelines(ELGs)promulgated by EPA under Section 304 of the CWA apply to your facility?
0 Yes ❑ No 3 SKIP to Section 6.
5.2 Provide the following information on applicable ELGs.
w ELG Category ELG Subcategory Regulatory Citation
CO
c
a
5.3 Are any of the applicable ELGs expressed in terms of production(or other measure of operation)?
th ElYes ElNo 3 SKIP to Section 6.
0
co 5.4 Provide an actual measure of daily production expressed in terms and units of applicable ELGs.
J O Unit of
Operation,Product,or Material Quantity per Day
-a Number Measure
a>
La
R
m
O
3
O
a`
EPA Form 3510-2C(Revised 3-19) Page 3

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0036773 Laurinburg WTP OMB No.2040-0004
SECTION 6.IMPROVEMENTS(40 CFR 122.21(g)(6))
6.1 Are you presently required by any federal,state,or local authority to meet an implementation schedule for constructing,
upgrading,or operating wastewater treatment equipment or practices or any other environmental programs that could
affect the discharges described in this application?
❑ Yes ❑ No 4 SKIP to Item 6.3.
6.2 Briefly identify each applicable project in the table below.
Affected Final Compliance Dates
Brief Identification and Description of Outfalls Source(s)of
c Project (list outfall Discharge Required Projected
c number)
E
c
N
0f
co
-12
0.
6.3 Have you attached sheets describing any additional water pollution control programs(or other environmental projects
that may affect your discharges)that you now have underway or planned?(optional item)
❑ Yes ✓❑ No ❑ Not applicable
SECTION 7.EFFLUENT AND INTAKE CHARACTERISTICS(40 CFR 122.21(g)(7))
See the instructions to determine the pollutants and parameters you are required to monitor and,in turn,the tables you must
complete.Not all applicants need to complete each table.
Table A.Conventional and Non-Conventional Pollutants
7.1 Are you requesting a waiver from your NPDES permitting authority for one or more of the Table A pollutants for any of
your outfalls?
❑ Yes El No 4 SKIP to Item 7.3.
7.2 If yes,indicate the applicable outfalls below.Attach waiver request and other required information to the application.
Outfall Number Outfall Number Outfall Number
7.3 Have you completed monitoring for all Table A pollutants at each of your outfalls for which a waiver has not been
�+ requested and attached the results to this application package?
El Yes 0 No;a waiver has been requested from my NPDES
03
permitting authority for all pollutants at all outfalls.
5 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
03
= listed in Exhibit 2C-3?(See end of instructions for exhibit.)
❑ Yes ElNo 4 SKIP to Item 7.8.
7.5 Have you checked"Testing Required"for all toxic metals,cyanide,and total phenols in Section 1 of Table B?
❑ Yes 0 No
7.6 List the applicable primary industry categories and check the boxes indicating the required GC/MS fraction(s)identified
in Exhibit 2C-3.
Primary Industry Category Required GC/MS Fraction(s)
(Check applicable boxes.)
❑Volatile 0 Acid ❑Base/Neutral 0 Pesticide
❑Volatile 0 Acid 0 Base/Neutral 0 Pesticide
❑Volatile 0 Acid 0 Base/Neutral 0 Pesticide
EPA Form 3510-2C(Revised 3-19) Page 4

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0036773 Laurinburg WTP 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 9 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 0 No
7.9 Have you provided(1)quantitative data for those Section 1,Table B,pollutants for which you have indicated testing is
required or(2)quantitative data or other required information for those Section 1,Table B,pollutants that you have
indicated are"Believed Present"in your discharge?
❑ Yes 0 No
7.10 Does the applicant qualify for a small business exemption under the criteria specified in the instructions?
❑ Yes. Note that you qualify at the top of Table B, p 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,
pollutants you have indicated are"Believed Present"in your discharge?
`—' ❑ Yes 9 No
d Table C.Certain Conventional and Non-Conventional Pollutants
7.12 Have you indicated whether pollutants are"Believed Present"or"Believed Absent"for all pollutants listed on Table C
for all outfalls?
❑ Yes ❑✓ No
c 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
tO "Believed Present"?
❑ Yes 0 No
Table D.Certain Hazardous Substances and Asbestos
7.14 Have you indicated whether pollutants are"Believed Present"or"Believed Absent"for all pollutants listed in Table D for
all outfalls?
O Yes 0 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 0 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?
O Yes 4 Complete Table E. 0 No 4 SKIP to Section 8.
7.17 Have you completed Table E by reporting qualitative data for TCDD?
❑ Yes ❑ No
SECTION 8.USED OR MANUFACTURED TOXICS(40 CFR 122.21(g)(9))
8.1 Is any pollutant listed in Table B a substance or a component of a substance used or manufactured at your facility as
an intermediate or final product or byproduct?
❑ Yes 0 No 4 SKIP to Section 9.
8.2 List the pollutants below.
g Fo 1. 4. 7.
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
NC0036773 Laurinburg WTP OMB No.2040-0004
SECTION 9. BIOLOGICAL TOXICITY TESTS(40 CFR 122.21(g)(11))
ithat any test for acute or chronic toxicityhas been made
9.1 Do you have any knowledge or reason to believe
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.
9.2 Identify the tests and their purposes below.
Test(s) Purpose of Test(s) Submitted to NPDES Date Submitted
Permitting Authority?
0
Quartly Chronic Toxicity
❑ Yes ❑ No
C)
O
0 ❑
inYes ❑ No
❑ Yes ❑ No
SECTION 10.CONTRACT ANALYSES(40 CFR 122.21(g)(12))
10.1 Were any of the analyses reported in Section 7 performed by 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 Envirochemental Chemist,lnc.
a)
Laboratory address 6602 Windmill Way
co
Wilmington,Nc 28405
co
O Phone number
[phone] -
Pollutant(s)analyzed Flouride
Total Copper
Total Aluminum
Total Nitrogen
Total Phosphourous
Hardness
SECTION 11.ADDITIONAL INFORMATION(40 CFR 122.21(g)(13))
11.1 Has the NPDES permitting authority requested additional information?
_ ❑ Yes ❑✓ No 4 SKIP to Section 12.
0
E 11.2 List the information requested and attach it to this application.
1. 4.
2. 5.
•a
3. 6.
EPA Form 3510-2C(Revised 3-19) Page 6

•
EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0036773 Laurinburg WTP OMB No.2040-0004
SECTION 12.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d))
12.1 In Column 1 below,mark the sections of Form 2C that you have completed and are submitting with your application.
For each section,specify in Column 2 any attachments that you are enclosing to alert the permitting authority.Note
that not all applicants are required to complete all sections or provide attachments.
Column 1 Column 2
❑ Section 1:Outfall Location El wl attachments
❑ Section 2:Line Drawing ❑ wl line drawing ❑ wl additional attachments
.171 Section 3:Average Flows and w/list of each user of
Treatment ❑ wl attachments ❑ privately owned treatment
works
❑ Section 4: Intermittent Flows ❑ w/attachments
El Section 5:Production ❑ w/attachments
w/optional additional
❑ Section 6:Improvements Elw/attachments ❑ sheets describing any
additional pollution control
plans
❑ w/request for a waiver and ❑ w/explanation for identical
supporting information outfalls
wl small business exemption wl other attachments
d 1-7
request El
❑ Section 7:Effluent and Intake ❑ w/Table A ❑ w/Table B
Characteristics
o
❑ w/Table C ❑ w/Table D
w/analytical results as an
❑ wl Table E ❑ attachment
Section 8:Used or Manufactured
❑ ❑ wl attachments
Toxics
❑ Section 9: Biological Toxicity ❑ w/attachments
Tests
❑✓ Section 10:Contract Analyses ❑ w/attachments
❑ Section 11:Additional Information ❑ w/attachments
❑ Section 12:Checklist and 0 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
Signature Date signed
EPA Form 3510-2C(Revised 3-19) Page 7

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1
EPA Identification Number NPDES Permit Number Facility Name Outfall Number I Form Approved 03/05/19
NC0036773 Laurinburg WTP 001 OMB No.2040-0004
i
TABLE A.CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(iii))1
Effluent Intake
Waiver (Optional)
e Units Maximum Maximum Long-Term
Pollutant Requested
(if applicable (specify) Daily Monthly Average Daily Number of Long-Term Number of
Discharge Discharge Discharge Analyses Average Value Analyses
(required) (if available) (if available) _
0 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.
Biochemical oxygen demand Concentration
1' ❑
(BOD5) Mass
Chemical oxygen demand Concentration
2' ❑
(COD) Mass
Concentration
3. Total organic carbon(TOC) ❑
Mass
Concentration Mg/L 45.0 mg/I 30.0 mg/I 2/.month
4. Total suspended solids(TSS) ❑
Mass
Concentration
5. Ammonia(as N) ❑
Mass
6. Flow ❑ Rate recording Continuous
Temperature(winter) ❑ °C °C
7.
Temperature(summer) 0 °C °C
pH(minimum) 0 Standard units s.u. 6.0
8. -
pH(maximum) ❑ Standard units s.u. 9.0
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

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EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19 .
NC0036773 Laurinburg WTP 001 OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence Intake
(check one) Effluent (optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Daily of Term of
Discharge Discharge Discharge Analyses Average Analyses
(required) (if available) (if available) Value
© Check here if you qualify as a small business per the instructions to Form 2C and,therefore,do not need to submit quantitative data for any of the organic toxic pollutants in Sections
2 through 5 of this table.Note,however,that you must still indicate in the appropriate column of this table if you believe any of the pollutants listed are present in your discharge.
Section 1.Toxic Metals,Cyanide,and Total Phenols
Antimony,total Concentration
1.1 (7440-36-0) ❑ �
Mass
Arsenic,total Concentration
1.2 (7440-38-2) El 0 El
1.3 Beryllium,total Concentration
(7440-41-7) ✓ Mass
Cadmium,total Concentration
1.4 (7440-43-9) 0 0 ❑ Mass
Chromium,total Concentration
1.5 (7440-47-3) ❑ Mass
1.6 Copper,total Concentration ug/l 13.6 10.8
(7440-50-8) Mass
Lead,total Concentration
1.7 (7439-92-1) El 0 ✓ Mass
Mercury,total Concentration
1.8 (7439-97-6) Mass
Nickel,total Concentration
1'9 (7440-02-0) 0 0 Mass
Selenium,total 0 Concentration
1.10 (7782-49-2) 0
Mass
Silver,total Concentration
1.11 (7440 22 4) ❑ 0 ❑
Mass
EPA Form 3510-2C(Revised 3-19) Page 11

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0036773 La u ri n bu rg WTP 001 OMB No.2040-0004
1
TABL . T•. u _ _. ' • _ •.=►• _► ' •: . . •. '• T_► ('I : 1 (')(7)(v))1
Presence or Absence Intake
(check one) Effluent
(optional)
Pollutant/Parameter Testing Units Long-Term _
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long Number
Present Absent Daily Monthly Dailishargey of Term of
Discharge) (ifavalablle) Discharge Analyses AverageValue Analyses
(if available)
Thallium,total Concentration
1.12 (7440-28-0) El 0 �
Mass
Zinc,total Concentration
1.13 0(7440-66-6) 0 ❑
Mass
1.14 Cyanide,total Concentration
(57-12-5) Mass
1.15 Phenols,total 0 0 2
Concentration
Mass
Section 2.Organic Toxic Pollutants(GC/MS Fraction—Volatile Compounds)
Acrolein Concentration
2.1 (107-02-8) 0 0 �
Mass
2.2 Acrylonitrile 12Concentration
0 0(107-13-1) Mass
Benzene Concentration
2.3 0 0(71-43-2) ✓ Mass
Bromoform Concentration
2.4 0 0(75-25-2) ✓ Mass
Carbon tetrachloride 0 0 Concentration
✓
2.5 (56-23-5) Mass
Chlorobenzene Concentration
2.6 (108-90-7) © Mass
Chlorodibromomethane Concentration
2.7 (124-48-1) Mass
2.8 Chloroethane 0 Concentration
(75-00-3) Mass
EPA Form 3510-2C(Revised 3-19) Page 12

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0036773 Laurinburg WTP 001 OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))'
Presence or Absence
(check one) Effluent Intake
(optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Daily of Term of
Discharge DfaCalablge) De ischarge Analyses AValuee Analyses
(if available)
2-chloroethylvinyl ether ✓ Concentration
2'9 (110-75-8) Mass
2.10 Chloroform(67-66-3) 0 Concentration
Mass
2.11 Dichlorobromomethane 0 0 El
Concentration
(75-27-4) Mass
212 1,1-dichloroethane � 0 Concentration
(75-34-3) Mass
2.13 12-dichloroethane 0 0 ci Concentration
(107-06-2) Mass
2.14 11-dichloroethylene 0 0 0 Concentration
(75-35-4) Mass
2.15 1,2-dichloropropane El Concentration
(78-87-5) Mass
2.16 1,3 dichloropropylene Concentration
(542-75-6) Mass
2.17 Ethylbenzene © Concentration
(100-41-4) Mass
2.18 Methyl bromide Ej Concentration
(74-83-9) Mass
2.19 Methyl chloride Concentration
(74-87-3) Mass
2.20 Methylene chloride 0 0 ✓� 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 .
NC0036773 Laurinburg WTP 001 OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one) Effluent Intake
(optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Daily of Term of
Discharge Discharge
Discharge Analyses Average Analyses
(required) (if f available) (if available) Value
2 22 Tetrachloroethylene I:: El0 ' Concentration
(127-18-4) Mass
Toluene 0 Concentration
2.23 (108-88-3) � 0 Mass
2.24 1,2-trans-dichloroethylene ❑ 1✓ Concentration
(156-60-5) Mass
2.25 1,1,1-trichloroethane ❑ Concentration
(71-55-6) Mass
2.26 1,1,2-trichloroethane Concentration
El El El
(79-00-5) Mass
2.27 Trichloroethylene � ❑ Concentration
(79-01-6) Mass
2.28 Vinyl chloride ❑ Concentration
El El
(75-01-4) Mass
Section 3.Organic Toxic Pollutants(GC/MS Fraction—Acid Compounds)
3.1 2-chlorophenol ❑ El
(95-57-8) Mass
2,4-dichlorophenol Concentration
3.2 (120-83-2) Mass
2,4-dimethylphenol Concentration
3.3 (105-67-9) Mass
4,6-dinitro-o-cresol Concentration
3.4 (534-52-1) Mass
3.5 2,4-dinitrophenol 1:1 Concentration
(51-28-5) ✓ Mass
EPA Form 3510-2C(Revised 3-19) Page 14

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19 •
NC0036773 Laurinburg WTP 001 OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))l
Presence or Absence Intake
(check one) Effluent (optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly ischarge Dail of Term of
Discharge D(favalablle) Discharge Analyses AValuee Analyses
(if available)
2-nitrophenol Concentration
3.6 (88-75-5) Mass
4-nitrophenol Concentration
3.7 0 El(100-02-7) © Mass
3.8 p-chloro-m-cresol � Concentration
(59-50-7) r Mass
3.9 Pentachlorophenol ❑ Concentration
(87-86-5) r Mass
Phenol Concentration
3.10 (108-95-2) ❑ El El
Mass
3.11 2,4,6-trichlorophenol ❑ ❑ ❑ Concentration
(88-05-2) Mass
Section 4.Organic Toxic Pollutants(GC/MS Fraction—Base/Neutral Compounds)
4.1 Acenaphthene ❑ Concentration
(83-32-9) ✓ Mass
Acenaphthylene Concentration
4.2 (208-96-8) El ❑ Mass
Anthracene ✓ Concentration
4.3 (120-12-7) Mass
4.4 Benzidine Concentration
r
(92-87-5) Mass
4.5 Benzo(a)anthracene ❑ El El
(56-55-3) _Mass
4.6 Benzo(a)pyrene 0Concentration
(50-32-8) Mass
EPA Form 3510-2C(Revised 3-19) Page 15

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0036773 Laurinburg WTP 001 OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence Intake
(check one) Effluent (optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long-
Number
Present Absent Daily Monthly Daily of Term of
Discharge Discharge Discharge Analyses Average Analyses
(required) (if available) Value
(if available
3,4-benzofluoranthene Concentration
4.7 (205-99-2) El ❑ Mass •
4 8 Benzo(ghi)perylene El ❑ ❑ Concentration
(191-24-2) Mass
4.9 Benzo(k)fluoranthene ❑ ❑ El Concentration I -
(207-08-9) Mass
4.10 Bis(2-chloroethoxy)methane El El0Concentration
(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
Bis(2-ethylhexyl)phthalate Concentration
4.13 (117-81-7) ❑ El
Mass
4-bromophenyl phenyl ether Concentration
4.14 (101-55-3) ❑ El © Mass
4.15 Butyl benzyl phthalate ❑ ❑ ❑ Concentration
(85-68-7) Mass
4.16 2-chloronaphthalene ❑ ❑ ❑ Concentration
(91-58-7) Mass
4-chlorophenyl phenyl ether 0 Concentration
4.17 (7005 72 3) ❑ El
Mass
Chrysene 0 Concentration
4.18 El
(218-01-9) ❑ Mass
4.19 Dibenzo(a,h)anthracene El ❑ 0 Concentration
(53-70-3) Mass
EPA Form 3510-2C(Revised 3-19) Page 16

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19 •
NC0036773 Laurinburg WTP 001 OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence Intake
(check one) Effluent (optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number.if available) Required Believed Believed (specify) Maximum Maximum Average Number Term Number
Present Absent Daily Monthly Daily of of
Discharge Discharge ' Discharge Analyses Average Analyses
(required) (if available) (available) Value
4.20 1,2-dichlorobenzene ❑ Concentration
(95-50-1) Mass
4.21 1 3-dichlorobenzene ❑ ❑ ❑ Concentration
(541-73-1) Mass
1,4-dichlorobenzene r Concentration
4.22 El 1:1
(106-46-7) Mass
4.23 3,3-dichlorobenzidine 0 El
Concentration
(91-94-1) Mass
4.24 Diethyl phthalate 0 ❑ © Concentration
(84-66-2) Mass
4.25 Dimethyl phthalate ❑ 0 r� Concentration
(131-11-3) Mass
4.26 Di-n-butyl phthalate ❑ Concentration
(84-74-2) Mass
4.27 2,4-dinitrotoluene ❑ ❑ Concentration
(121-14-2) Mass
4.28 2,6-dinitrotoluene ❑ 0 © Concentration
(606-20-2) Mass
Di-n-octyl phthalate El Concentration
4.29 (117-84-0) Mass
4.30 1,2-Diphenylhydrazine ID Concentration
(as azobenzene)(122-66-7) Mass
4.31 Fluoranthene El Concentration
0 El
(206-44-0) Mass
4.32 Fluorene El Concentration
El 1:1
(86-73-7) Mass
EPA Form 3510-2C(Revised 3-19) Page 17

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0036773 Laurinburg WTP 001 OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))l
Presence or Absence
(check one) Effluent Intake
(optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly of of
Term
Discharge Discharge DisDcharge Analyses Average Analyses
(required) (if available) Value
(if available)
Hexachlorobenzene 0 Concentration 1
4.33 0 El
(118-74-1) Mass
4.34 Hexachlorobutadiene Concentration
El 0
(87-68-3) ✓ Mass
4.35 Hexachlorocyclopentadiene ❑ ❑ Concentration
(77-47-4) Mass
4.36 Hexachloroethane 0 ❑ ❑ Concentration
(67-72-1) Mass
4.37 Indeno(1,2,3-cd)pyrene 0 El ✓❑ Concentration
(193-39-5) Mass
4.38 Isophorone Concentration
El 0
(78-59-1) ✓ Mass
4.39 Naphthalene ❑ Concentration
(91-20-3) Mass
4.40 Nitrobenzene Concentration
0 El
(98-95-3) ✓ Mass
4.41 N-nitrosodimethylamine El Concentration
El 0
(62-75-9) Mass
4.42 N-nitrosodi-n-propylamine ❑ Q Concentration
621-64-7
( ) Mass
N-nitrosodi hen famine Concentration
P Y0 0
4.43 (86-30-6) Mass
4.44 Phenanthrene El0Concentration
(85-01-8) Mass
Pyrene Concentration
4.45 (129-00-0) Mass
EPA Form 3510-2C(Revised 3-19) Page 18

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19 •
NC0036773 Laurinburg WTP 001 OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))l
Presence or Absence
(check one) Effluent Intake
(optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (Specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Term
of of
Discharge Discharge pisDcharge Analyses Average Analyses
(required) (if available) if available Value
4.46 1,2,4-trichlorobenzene Concentration
0 0 0
(120-82-1) Mass
Section 5.Organic Toxic Pollutants(GC/MS Fraction—Pesticides)
Aldrin Concentration
5.1 0(309-00-2) ❑ ❑
Mass
a-BHC Concentration
5.2 0(319-84-6) 0 ❑ Mass
5.3 R-BHC Concentration
El El El
(319-85-7) Mass
y-BHC 0 Concentration
5.4 (58-89-9) Mass
b-BHC Concentration
5.5 0 El
(319-86-8) ✓ Mass
5.6 Chlordane E Concentration
0 0
(57-74-9) Mass
4,4'-DDT Concentration
5.7 0 0 0
(50-29-3) Mass
4 4'-DDE Concentration
5.8 0 0(72-55-9) ✓ Mass
4,4'-DDD Concentration
5.9 0 0(72-54-8) ✓ Mass
Dieldrin Concentration
5.10 (60-57-1) 0 0 ❑
Mass
5.11 a-endosulfan Concentration
0 0 0
(115-29-7) Mass
EPA Form 3510-2C(Revised 3-19) Page 19

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19 •
NC0036773 Laurinburg WTP 001 OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence Intake
(check one) Effluent
(optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Term
of
D(req i a ischar9e t) (f available)ischarge aily of
Di c harge Analyses AverageValue Analyses
(if available)
R-endosulfan El 0 ❑ Concentration
5.12 (115-29-7) Mass
Endosulfan sulfate Concentration
5.13 (1031-07-8) 0 0 ❑ Mass
5.14 Endrin 0
0
❑ Concentration
(72-20-8) Mass
Endrin aldehyde 0 ❑ ❑ Concentration
5.15 (7421-93-4) Mass
Heptachlor 0 0 ❑ Concentration
5.16 (76-44-8) Mass
Heptachlor epoxide Concentration
5.17 (1024-57-3) 0 0 E Mass
PCB-1242 Concentration
5.18 (53469-21-9) 0 0
Mass
PCB-1254 Concentration
5.19 (11097-69-1) ❑ ❑ E Mass
PCB-1221 Concentration
5.20 (11104-28-2) 0 0 g Mass
PCB-1232 Concentration
5.21 (11141-16-5) ❑ 0 0 Mass
PCB-1248 Concentration
5.22 (12672-29-6) ❑ ❑
Mass
PCB-1260 Concentration
5.23 (11096-82-5) 0 0 0 Mass
PCB-1016 Concentration
5.24 (12674-11-2) 0 ❑ 0 Mass
EPA Form 3510-2C(Revised 3-19) Page 20

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19 •
NC0036773 Laurinburg WTP 001 OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence Intake
(check one) Effluent
(optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Daily of Term of
Discharge
(required) (if available) Discharge Analyses AValuee Analyses
Toxaphene Concentration
5.25 (8001-35-2) ❑ I=1 D 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

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EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19 •
NC0036773 Laurinburg WTP OMB No.2040-0004
TABLE C.CERTAIN CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(vi))1
Presence or Absence Intake
(check one) _ Effluent (Optional)
Units
Pollutant Maximum Long-Term
Believed Believed (specify) Maximum Daily Monthly Average Daily Number of Long-Term Number of
Present Absent Discharge Discharge Discharge Analyses Average Analyses
(required) Value
_i (if available) (if available)
0 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
(24959-67-9) Mass
Chlorine,total Concentration ug/I 17
2. residual ❑ Mass
3. Color El El
Concentration
Mass
Concentration
4. Fecal coliform ❑ 0 Mass
5 Fluoride ❑ 0 Concentration ug/I 2467
(16984-48-8) Mass
Concentration
6 Nitrate-nitrite 0 0 Mass
7 Nitrogen,total ❑ 0 Concentration mg/I Monitor/report Monitor/report
organic(as N) Mass
Concentration
8. Oil and grease ❑ 0 Mass
9 Phosphorus(as ❑ ❑ Concentration mg/I Monitor/report Monitor/report
P),total(7723-14-0) Mass
10. Sulfate(as SO4) ❑ Concentration
(14808-79-8) ✓ Mass
Concentration
11. Sulfide(as S) 0 0 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 •
NC0036773 Laurinburg WTP OMB No.2040-0004
TABLE C.CERTAIN CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(vi))1
Presence or Absence Intake
(check one) Effluent (Optional)
Pollutant Units Maximum Long-Term
Believed Believed (specify) Maximum Daily Long-Term
Present Absent Discharge Monthly Average Daily Number of Average Number of
Discharge Discharge Analyses Analyses
(required) Value
(if available) (if available)
T
12 Sulfite(as SO3) ❑ © Concentration
(14265-45-3) Mass
Concentration
13. Surfactants ❑ © Mass
14. Aluminum,total ❑ ❑ Concentration ug/I Monitor/report Monitor/report
(7429-90-5) Mass
15. Barium,total 0 ❑ Concentration
(7440-39-3) Mass
16. Boron,total 0 © Concentration
(7440-42-8) Mass
1 Cobalt,total 0 © Concentration
(7440-48-4) Mass
18 Iron,total ❑ © Concentration
(7439-89-6) Mass
19 Magnesium,total ❑ © Concentration
(7439-95-) Mass
Molybdenum, Concentration
20. total 0 © Mass
(7439-98-7)
21. Manganese,total ❑ © Concentration
(7439-96-5) Mass
22. Tin,total 0 © Concentration
(7440-31-5) Mass
23. Titanium,total ❑ © Concentration
(7440-32-6) Mass
EPA Form 3510-2C(Revised 3-19) Page 24

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19 •
NC0036773 Laurinburg WTP OMB No.2040-0004
TABLE C.CERTAIN CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(vi))1
Presence or Absence Intake
(check one) Effluent (Optional)
Units
Pollutant Maximum Long-Term
Believed Believed (specify) Maximum Daily Monthly Average Daily Number of Long-Term Number of
Present Absent Discharge Discharge Discharge Analyses Average Analyses
(required) Value
(if available) (if available)
24. Radioactivity
Concentration
Alpha,total ❑ © Mass
Concentration
Beta,total ❑ © Mass
Concentration
Radium,total ❑ © Mass
Radium 226,total 0 © ConcentrationMass
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

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EPA Identification Number NPDES Permit Number Facility Name Outfall Number I Form Approved 03/05/19
NC0036773 Laurinburg WTP 001 OMB No.2040-0004
TABLE D.CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 122.21(g)(7)(vii))1
Presence or Absence
Pollutant (check one) Reason Pollutant Believed Present in Discharge Available Quantitative Data
Believed Believed (specify units)
Present Absent
1. Asbestos ❑ El
2. Acetaldehyde ❑ ca
3. Allyl alcohol ❑
4. Allyl chloride ❑
5. Amyl acetate ❑ El
6. Aniline ❑
7. Benzonitrile 0 El
8. Benzyl chloride ❑ El
9. Butyl acetate 0 El
10. Butylamine 0 El
11. Captan 0
12. Carbaryl ❑ 12
13. Carbofuran 0
14. Carbon disulfide ❑
15. Chlorpyrifos ❑ El
16. Coumaphos 0
17. Cresol ❑ El
18. Crotonaldehyde 0 El
19. Cyclohexane 0 El
EPA Form 3510-2C(Revised 3-19) Page 27

EPA Identification Number NPDES Permit Number I Facility Name Outfall Number Form Approved 03/05/19
NC0036773 Laurinburg WTP ow. OMB No.2040-0004
TABLE D.CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 122.21(g)(7)(vii))1
Presence or Absence
Pollutant (check one) Reason Pollutant Believed Present in Discharge Available Quantitative Data
Believed Believed (specify units)
Present Absent
20. 2,4-D(2,4-dichlorophenoxyacetic acid) 0 El
21. Diazinon ❑
22. Dicamba ❑
23. Dichlobenil 0
24. Dichlone ❑
25. 2,2-dichloropropionic acid El
26. Dichlorvos ❑
27. Diethyl amine ❑
28. Dimethyl amine 0 El
29. Dintrobenzene 0
30. Diquat ❑
31. Disulfoton 0 El
32. Diuron ❑ El
33. Epichlorohydrin ❑
34. Ethion 0 EI
35. Ethylene diamine 0
36. Ethylene dibromide 0 12
37. Formaldehyde ❑ El
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
NC0036773 Laurinburg WTP ow. OMB No.2040-0004
TABLE D.CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 12221(g)(7)(vii))1
Presence or Absence
Pollutant (check one) Available Quantitative Data
Believed Believed Reason Pollutant Believed Present in Discharge (specify units)
Present Absent _
39. Guthion ❑
40. Isoprene ❑
41. lsopropanolamine ❑
42. Kelthane ❑ 121
43. Kepone 0 121
44. Malathion 0
45. Mercaptodimethur 0 0
46. Methoxychlor ❑ 0
47. Methyl mercaptan 0 0
48. Methyl methacrylate ❑ El
49. Methyl parathion 0 0
50. Mevinphos 0 0
51. Mexacarbate 0 0
52. Monoethyl amine 0 0
53. Monomethyl amine ❑ 0
54. Naled ❑ 0
55. Naphthenic acid 0 El
56. Nitrotoluene 0 0
57. Parathion ❑ 0
EPA Form 3510-2C(Revised 3-19) Page 29

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0036773 Laurinburg WTP 001 OMB No.2040-0004
TABLE D.CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 12221(g)(7)(vii))l
Presence or Absence
Pollutant (check one) Available Quantitative Data
Believed Believed Reason Pollutant Believed Present in Discharge (specify units)
Present Absent
58. Phenolsulfonate ❑ 0
59. Phosgene ❑ 0
60. Propargite ❑ 0
61. Propylene oxide ❑ 0
62. Pyrethrins ❑ 0
63. Quinoline 0 0
64. Resorcinol ❑ ❑✓
65. Strontium 0 0
66. Strychnine ❑ 0
67. Styrene 0 0
68. 2,4,5-T(2,4,5-trichlorophenoxyacetic ❑ 0
acid)
69. TDE(tetrachlorodiphenyl ethane) 0 0
70. 2,4,5-TP[2-(2,4,5-trichlorophenoxy) ❑ ❑
propanoic acid]
71. Trichlorofon ❑ 0
72. Triethanolamine ❑ 0
73. Triethylamine ❑ 0
74. Trimethylamine 0 0
75. Uranium 0 0
76. Vanadium ❑ ❑✓
EPA Form 3510-2C(Revised 3-19) Page 30

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0036773 Laurinburg WTP 001 OMB No.2040-0004
TABLE D.CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 122.21(g)(7)(vii))1
Presence or Absence
Pollutant (check one) Reason Pollutant Believed Present in Discharge Available Quantitative Data
Believed Believed (specify units)
Present Absent
77. Vinyl acetate ❑ El
78. Xylene ❑ ❑✓
79. Xylenol ❑ El
80. Zirconium ❑ ❑r
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
NC0036773 Laurinburg WTP OMB No.2040-0004
TABLE E.2,3,7,8 TETRACHLORODIBENZO P DIOXIN(2,3,7,8 TCDD)(40 CFR 122.21(g)(7)(viii))
TCDD Presence or
Congeners Absence
Pollutant Used or (check one) Results of Screening Procedure
Manufactured Believed Believed
Present Absent
2,3,7,8-TCDD ❑ ❑ 0
EPA Form 3510-2C(Revised 3-19) Page 33