NC0026441_Industial Waste Survey_20180219

CAS®b
?caws 4 5d" eaf
Public Works and Utilities
February 19, 2018
Certified
Ms. Deborah Gore
PERCS Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Dear Ms. Gore
�R
OWED���
e
Enclosed is the information needed for the Industrial Waste Survey There were ten short forms and one
long form sent out to these industries and businesses. The list of businesses was compiled from the
water and sewer bills and by the privilege license master list compiled by the town's Finance
Department. Attempted to find the NC Manufacturer's Register and could not locate the website. If you
have a good website for the Register, please let me know.
The city uses the following methods for implementing the continuous survey requirements and staying
aware of new or changed users.
The Director of Public Works and Utilities:
1. Meets with the Planning Department anytime a new business is considering coming to Siler City.
2. Meets with Building Inspector as well as the Planning Director to review any site plans that are
presented to the town
3. Gets a list of all request for water and sewer from the Billing Department.
4. Reviews the new business license list monthly.
Below is a list of the industries that are not on the Town of Siler City's sewer system:
• International Precast, Inc., 2469 Old US 421 N. Siler City, NC
Industries that have closed since 2012:
• Caviness Printing, 224 E Raleigh Street, Siler City, NC
• Unrene Furniture, Inc. 3315 Highway 421 N, Siler City, NC
• Olympic Steel, 3031 Hamp Stone Road, Siler City, NC

Deborah Gore-PERCS Letter
February 19, 2018
Page 2
Below is a list of industries and businesses that are domestic only:
• MASACME (formally Acme McCrary), 1311 E. 11th Street, Siler City, NC
• Basic Machinery, 1220 Harold Andrews Road, Siler City, NC
• Chatham Trades, 909 Alston Bridge Road, Siler City, NC
• Lazaar Industry, 3025 Hamp Stone Road, Siler City, NC
• Lloyd's of Chatham, 55 Industrial Park, Siler City, NC
Below is a list of industries and businesses that the processed water does not come back to the Town of
Siler City's sewer:
• Carolina Wood, 902 S. Chatham Avenue, Siler City, NC
• Chandler Concrete, 804 S. Chatham Avenue, Siler City, NC
• Engineered Plastic Components, Inc., 920 E. Raleigh Street, Siler City, NC
• Floorazzo Tile, 215 W. Third Street, Siler City, NC
• ProKleen Dry Cleaners, 601 E. Third Street, Siler City, NC
Industries that do send water back to the Siler City sewer system:
• Chaudhry Halal Meat Co., 380 Stockyard Road, Siler City, NC
I am enclosing the IWS checklist and the long and short form surveys.
Should you have any questions, please do not hesitate to let me know.
Thank you,
a ttg
Chris McCorquodale
Town of Siler City
Chris McCorquodale
WWTP Superintendent
PO Box 769. 198 Utility Drive
Siler City, NC 27344-0769
[e-mail]
Phone: [phone] • Fax: [phone]
www.silercity.org
7o wlvcrm cr C7;°1 (ime1 of k for oursivecSti do oz,, � bulart(`f'd yiwei ria ce, C{'J airIit j;Qt"nm rslf pt , CIYIt{ ft17 81J (ky, ,d ,ot!nimrtity

IWS CHECKLIST
Check if
Industry Name
No Sewer
Approx.
Include all industries sent
Service or
Check if
process or
other non-
Explanation of why SIU permit is or
short forms and all
not in
Date short
Date
Date long
Domestic
domestic
isn't needed
industries in NC
business
form was
of site
form was
Flow only
Flow
(i.e Non -categorical, <25,000 gpd and
Manufacturers Register)
Source
X
received
visit
received
X
d
Description of Business
<5% MAHL or no potential to impact)
1/05/2018
Steel Fabrication and
Domestic only
Basic Machinery
X
Manufacture Mach
2/22/2018
930
Dry kiln -Water used for boiler does not
Carolina Wood
gal/day
Sawmill -Lumber
go to sewer
Production of Ready mix
Water used mixing concrete, fill water
1/06/2018
423
concrete
tank on trucks, sprinkle stockpile and
Gals/day
truck wash Does not come back to
Chandler Concrete
City
Package and assemble
1/08/2018
X
products for others
Domestic only
Chatham Trades, Inc
X
Cavmess Printing
2/23/2018
136363
Infected Molded
Process is closed loop Water goes in
Plastic Components
cooling tower and is recycled to cool
Engineered Plastic
the molds and machines Does not come
Components, Inc
back to City
250
Commercial Tile
Re -circulate using non -potable water
2/26/2018
Manufacturer
Two hot water tanks to refill after
evaporation Does not come back to
Floorazzo
City
1/18/2018
X
Upholstered Furniture
Domestic only
Lazar Industries
X
Lmrene Furniture Inc
12/23/2018
X
Upholstered Furniture
Domestic only
Lloyd's of Chatham
Distribution and
MASACME
1/05/2018
X
Warehouse
Domestic only
(formally Amce-McCrary)

Industry Name
Include all industries sent
short forms and all
industries in NC
Manufacturers Register)
Source
Check if
No Sewer
Service or
not in
business
M
Date short
form was
received
Date
of site
visit
Date long
form was
received
Check if
Domestic
Flow onlyFlow
X
Approx.
process or
other non-
domestic
d
Description of Business
Explanation of why SN permit is or
isn't needed
(i.e Non -categorical, <25,000 gpd and
<5% MAHL or no potential to impact)
Pro Kleen Dry Cleaners
2/22/2018
841
Gals/day
Dry Cleaning Service
Water is used to cool motor used for
cooling water that's used to cool the
dry-cleaning machines Water is 75%
recycled No potential impact
Chaudhry Halal Meat
Company
2/21/2018
2700
Gal/day
Meat Packing Facility
A meat packing facility using approx
2700 gals/day Blood is separated into a
tank and picked up by a contract hauler
International Per -cast, Inc
X
Olympic Steel
X

Industrial Waste Survey Short Form
1'his farm has been sent to your business to determine i%pcs and sources of wastewater that are enterintl the
Stier Cit} WWTP 'Phis form must be completed in accordance with section 27-131 of our Sewer Use
Ordinance (NC Model Section 5.7) Our Sewer Use Ordinance can he examined during normal hustnesS
hours at the addres, listed below If you have any question or concerns while co
tnpieung the form. plan,;
contact 'l err) Green 919-742-4711
Name of Business
Adds c„
Cit)IState/Zip Cod
Telephone.
Number of Employ
What Standard Industrial clas,ttication (Sl(`) Code(,) do )cru report under
I3ricil}° di cr►bc Y0,Ur business include products manulactured or ser%ices performed
l �' toy_ i% �LfL sf
Plca,c list all I -Ater uses ami approximate volume used in gallons per day for cacti use, includiwi fac ihty
%a,hdv%kn waier. -
',Fater U,u
Volume Used (gallon, per
dav)
Prc2te„-
Facility Wastidown
IJoancstic(bathro om> ,, cafeteria)
`I'c2tal.
Our `,east UNC ("Ina"Lc require,, that an Authoriied Representative ofthc User sign gill reports to the Scorer
Authority authorized Representative is defined as a Person responsible fol Principle Business decisions air
other pohc% decision, for the faulity
1`o the Best of my knowledge the inlormation on this Conn i, true and accurate,
ignaipcs�}'��C _Date
Titlei s
iZetaarn this form by: Fetrrteary 10, 2018 to: Chris 'xi,r* ........A i cxtti-r•n o
Town of Siler Citv
P.O. Box 769 (311 N. Second Ave.
Siler City, N.C. 27344
Failure to return this form is enforceable: in accordance with the sew,;r Ute Ordinancc:
I 44 s y or• Form
i"Ii M1.l SIi4 i145 Sllc`.1 1'02 til
Rr,t,itntitle 5epi:172bce 1 1991

Industrial Waste Survey Short Form
This form has been sent to your business to determine types and sources of wastewater tha d eUhtering the
Siler City WWTP This form must be completed in accordance with section 27-131 of our Sewer Use
Ordinance (NC Model Section 5 7) Out Sewer Use Ordinance can be examined during normal business
hours at the address listed below If you have any question or concerns while completing the foim please
contact Terry Green 919-742-4732
Name of Business 64 S (C 4 aA t ;e.( 7 Z2c Jlde,
Address ')"'20 /-jar6 rW 2 j
City/State/Zip Code 4 f er 6 4 A/ C Z-TskOY
Telephone 9f �'GG3'Z27�`f Fax %/ 9 _ �� Z l ? ;2-
Number
L
Number of Employees (a S -
What Standard Industrial Classification (SIC) Code(s) do you repoit under
Briefly describe your business include products manufactuied or services performed
hvFt,lnl14d
Please list all water uses and approximate volume used in gallons per day for each use, including facility
washdown water
Water Use
Volume Used (gallons per
day)
Process
!iY S / ;D <- /f 0615iT ill -t', -I WjMrr.
Facility Washdown
Domes tic (bathrooms, cafeteria)
d
Total
Our Sewer Use Ordinance requites that an Authorized Representative of the User sign all reports to the Sewer
Authority Authorized Representative is defined as a Person responsible for Principle Business decisions or
other policy decisions for the facility
To the Best of my knowledge the information on this form is true and accurate,
Signature % Date 3 /
Title
Return this form by: January 10, 2018 to:
Terry Green, Director of Public Works & Utilities
Town of Siler City
P.O. Box 769 (311 N. Second Ave.
Siler City, N.C. 27344
Failure to return this form is enforceable in accordance with the Sewer Use Ordinance
IWS Short Form
Filename IWS Short Form
Revision Date September 1, 1993

Industrial Waste Survey Short Form
This form has been sent to your business to detetrmne types and sources of wastewater that aie entering the
Siler City WWTP This form must be completed in accordance with section 27-131 of our Sewer Use
Oidinance (NC Model Section 5 7) Our Sewer Use Ordinance can be examined during normal business
hours at the address listed below If you have any question of concerns while completing the form, please
contact Terry Green 919-742-4732
Name of Business
Addi ess
City/State/Zip Code
aro)ina- Wo
Telephone Fax
Mlle r�ofE`mpIoyees
What Standard Industrial Classification (SIC) Code(s) do you report under
Briefly describe your business include products manufactured or services performed
1L-rnLe -'-�Qnt'cfiac
C
r:i 1
,"
BY. L-� —.- -
L - - —.- - i
Please list all water uses and approximate volume used in gallons per day for each use, including facility
o ch rinwn —ntpr
Water Use
Volume Used (gallons per
day)
Process
Facility Washdown
Domestic(bathrooms, cafeteria) & .OU S
&-7J
Total
3
Our Sewei Use Ordinance requires that an Authorized Representative of the User sign all reports to the Sewer
Authority Authorized Representative is defined as a Person responsible for Pimciple Business decisions or
other policy decisions for the facility.
To the Best of my knowledge the information on this form is true and accurate,
Signature Date c�— ` 9— IO
Title re 1
Return this form by: February 10, 2018 to:
Terry Green, Director of Public Works & Utilities
Town of Siler City
P.O. Box 769 (311 N. Second Ave.
Siler City, N.C. 27344
Failure to return this form is enforceable in accordance with the Sewer Use Ordinance.
IWS Short Form
Filename IWS Short Form
Revision Date September 1, 1993
:VJ

/6 -
Industrial Waste Survey Short Form
This form has been sent to your business to determine types and sources of wastewater that are entering the
Siler City WWTP. This form must be completed in accordance with section 27-131 of our Sewer Use
Ordinance (NC Model Section 5.7). Our Sewer Use Ordinance can be examined during normal business
hours at the address listed below. If you have any question or concerns while completing the form, please
contact Terry Green 919-742-4732
Name of Business C 'Ara 1 r Q �6 W cre' 0 Cowy%V" J:Wc j
Address g'cH 5,,A ('_{,� .. N ML#-- y
p
City/State/Zip Code C�L�
Telephone r119- SLS -1 13& Fax
Number of Employees I d A' , LO -
What Standard Industrial Classification (SIC) Code(s) do you report under
3 a 7 5 . ---- - ---- _ —
Briefly describe your business include products manufactured or services performed
r-o>NertN-- Jt,cuAm em
Please list all water uses and approximate volume used in gallons per day for each use, including facility
washdown water.
Water Use
Volume Used (gallons per
day)
Process
ya� er da
Facility Washdown
d0
Domestic(bathrooms, cafeteria)
so
Total-
14
Our Sewer Use Ordinance requires that an Authorized Representative of the User sign all reports to the Sewer
Authority. Authorized Representative is defined as a Person responsible for Principle Business decisions or
other policy decisions for the facility
To the Best of my knowledge the information on this form is true and accurate,
I Title
Return this form by: January 10, 2018 to: Terry Green, Director of Public Works & Utilities
Town of Siler City
P.O. Box 769 (311 N. Second Ave.
Siler City,,N.C. 27344
Failure to return this form is enforceable in accordance with the Sewer Use Ordinance.
1WS Short Form

Industrial Waste Survey Short Form FMZ�—nterjn_g-the
This form has been sent to your business to determine types and sources of wastewater tha••.•••.••
Siler City WWTP This form must be completed in accordance with section 27-131 of our Sewer Use
Ordinance (NC Model Section 5 7) Our Sewer Use Ordinance can be examined during normal business
hours at the address listed below If you have any question or concerns while completing the form, please
contact Terry Green 919-742-4732
Name of Business C Via t -h a m Trades, Ino—
Address q 0 9 A t S -�O n 3n d o e, 1`1 d I A0, IJ o -x 5)1
City/State/Zip Code S i I e f C ay ill C J f- � 3 4� q
Telephone iG ' -3Fax q —/
Number of Employees
What Standard Industrial Classification (SIC) Code(s) do you report under
-� -a -31, - - - - , - - - - , ----
Briefly describe your business include products manufactured or services performed
I� rne-nfi r)in. dl 1 ts iri e1Yctuo-1 a-nc�
Please list all water uses and approximate volume used in gallons per day for each use, including facility
washdown water
Water Use
Volume Used (gallons per
day)
Process
Q
Facility Washdown
Domestic (bathrooms, cafeteria)
Total
Our Sewer Use Ordinance requires that an Authorized Representative of the User sign all reports to the Sewer
Authority Authorized Representative is defined as a Person responsible for Principle Business decisions or
other policy decisions for the facility
To the Best Q my�je then rmation on this for is t ue and accurate,
Signature, Date I �J I
Title LXe�-h Je, i j-eCtD1r
Return this form by: January 10, 2018 to:
Terry Green, Director of Public Works & Utilities
Town of Siler City
P.O. Box 769 (311 N. Second Ave.
Siler City, N.C. 27344
Failure to return this form is enforceable in accordance with the Sewer Use Ordinance
IWS Short Form
Filename IWS Short Form
Revision Date September 1, 1993

ZU16-U1-US 18:54 abc 1Z3 >a 9196633874
Industrial Waste Survey Short Form
This titan has been sunt to your hwonem to detcrniilie tyles tint( sours c, of wusimaler dial the emering tlhc
Siler City WWTP. This fuim must he coniplolod In timordanut, with scettcin 27.131 al' our Scwcr Use
Uidinancc (NC Madel .Suction 5.7). Out Sewer We Ordinance call be examined during, normal humnasa
hours at the addles listed below 1.1 you have any question or conc:orns while rumpledng the form. please
contact 1 ei ry Grmn 919-7742-4732.
Name o f $ ttsi nt
Address %tel/
City/Stalu/7ip Code -S4'Frz Z73OV
MIX:
tx:
Numhar of Cmplo}lues X40
What. Siandard Industrial Chty ilicatian (SIC) Code(%1 do yon re:ptim under:
Brielly descrihu your business ntulucic Itrtttlut:tt tltatlt1litt:Itiled or ai:iI,icus performed
Please list all water u.nes attd approximate volutne uscd in d ullom per Clay Ior c ach u%e, including facility
washdown water.
Water Use
Volurne Used (gallons put-
ct-
ria )
(Jay)
Prciccss
�j
Facile , Wa4hdown
Domemic:(hathri om-,. eafeierl:l)
Tolal:
+ I
UurSewer UNe Ordinance: icc)ulccx that all Atttluiri/ed ltcpresLntaiive ofthe U%er zigri tll report%tri the Scwcr
Amhority, Autlturircd Relrescot:stivc cc ticlincd ati a Pcrsan rusleintithle fitr Pr tnciplc T3usinc�, decisions or
other policy dneisions For the finclthy.
'I"n the oost ar
XZ -
Title o e the infMnUitttiit an 111i', fisc m 1ti true acus crceutatc,
Return this form by: ,l<attuary 10, 2018 to:
Terry Green, Director of Public Works & Utiiitie,7
Towtl of Siler City
P.O. Box 769 (311 N. SLcnnd Ave.
Siler City, N.C. 27344
Failure to tewl n this (,(It to is eltlumcable in accordance with ilia Sewer 1,)%t: (irttinancu
1WS 511cm Faris
I'kil me IWSSiiaiirnttti
RuviKtnn Ot iw, Scpteint%er i. 1491

Industrial Waste Survey Short Form
This form has been sent to your business to determine types and sources of wastewater that are entering the J
Silei City WWTP This form must be completed in accordance with section 27-131 of our Sewer Use �J
Ordinance (NC Model Section 5 7) Our Sewer Use Ordinance can be examined during normal business
hours at the address listed below If you have any question or concerns while completing the form, please
contact Terry Green 919-742-4732` j
Name of Business "S of` -
Address 5 S 5 , I-e'e C r 1" Lt4y- I'd ear l& .bY,
City/State/Zip Code er C r \j C,
Telephone L3 1 q -'14-1 Fax 17 19 - 1663a
Numbei of Employees 37
What Standard Industrial Classification (SIC) Code(s) do you report under
Briefly describe your business include products manufactured or services performed
Please list all water uses and approximate volume used in gallons per day for each use, including facility
wndidr)%xm xx atar
Water Use
5 -
Volume Used (gallons per
day)
Process
Facility Washdown
Domestic(bathrooms, cafeteria)
% 915-
5Total
Total
?-
Our Sewer Use Ordinance requires that an Authorized Representative of the User sign all reports to the Sewer
Authority Authorized Representative is defined as a Person responsible for Principle Business decisions or
other policy decisions for the facility
To the Best of my knowledge the information on this form is true and accurate,
Signatu elI1cJ ��.d1,xeL� Date la �- �7
Title % r r ?G MA—
Return this form by: January IU, GUlif to:
ferry careen, liirector of rubuc worxs & ututnes
Town of Siler City
P.O. Box 769 (311 N. Second Ave.
Siler City, N.C. 27344
Failure to return this form is enforceable in accordance with the Sewer Use Ordinance
IWS Short Form
Filename IWS Short Form
Revision Date September 1, 1993

Industrial Waste Survey Short Form
This form has been sent to your business to determine types and souices of wastewater that ate entering the
Siler City WWTP, This form must be completed in accordance with section 27-131 of our Sewer Use
Oidinance (NC Model Section 5.7). Our Sewei Use Ordinance can be examined during normal business
hours at the address listed below If you have any question of conceins while completing the form. please
contact Terry Green 919-742-4732.
Name of Business L - GI Zu
Address 302
JA
City/State/Zip Code _ =, �r` e, C 1 'f !i A) q
Telephone 9lei- 7°(Z " 93 ®, Fax -
Number
-1 -)`I2 &(5)-oNumber of Employees —i 1
What Standaid Industiial Classification (SIC) Codc(s) do you report under.
Bi iefly describe your business include products manufactured or services pciformed
Please list all water uses and approximate volume used in Gallons per day for each use, including facility
washdown water.
Water Use
Volume Used (gallons pet
day)
Pi ocess. ? C) ,
Facility Waslidown
Domestic(bathrooms, cafeteria)
t 1 C:)C ,
Total
k- oC
Our Server Use Otdmance requires that an Authorized Repi esentative of the User sign all repoi is to the Sewer
Authotrty. Authoil7ed Representative is defined as a Pcrson responsible for Pimciple Business decisions or
other policy decis ons for the facility
To the
Best odknowledgeA infoi rrir .in on this form is it ue and accur ate,
1 Si
I Title
Return this form by: January 10, 2018 to:
Terry Green, Director of Public Works & Utilities
Town of Siler City
P.O. Box 769 (311 N. Second Ave.
Siler City, N.C. 27344
Failure to i etui n this form is enforceable in accordance with the Sewei Use Ordinance
IWS Short I-01111
Filename. 1WS Short Form
Revision Date September 1 1991

Industrial Waste Survey Short Form
a
This form has been sent to your business to deterrmne types and sources of wastewater that are entering the
Siler City WWTP This form must be completed in accordance with section 27-131 of our Sewer Use
Ordinance (NC Model Section 5 7) Our Sewer Use Ordinance can be examined during normal business
hours at the address listed below If you have any question or concerns while completing the form, please
contact Terry Green 919-742-4732
Name of Business \-) ih 1' ti `1 L4r wL
Address
3
City/State/Zip Code 4L'R. �• �� G `�7
Telephone- X11`'1 W -o' --3(d, 7Fax
Number of Employees lU
What Standard Industrial Classification (SIC) Code(s) do you report under
Briefly describe your business include products manufactured or services performed
'. , — t;kiJC -4':
Please list all water uses and approximate volume used in gallons per day for each use, including facility
wnchrinwn venter
Water Use
Volume Used (gallons per
day)
Process
Facility Washdown
Domestic(bathrooms, cafeteria)
Total
L
Our Sewer Use Ordinance requires that an Authorized Representative of the User sign all reports to the Sewer
Authority Authorized Representative is defined as a Person responsible for Principle Business decisions or
other policy decisions for the facility
To the Best a my knowledge the informati ei this form is true and accurate,
Signature i ate
Title
Return this form by: February 10, 2018 to:
Chris McCorquodale WWTP Superintendent
Town of Siler City
P.O. Box 769 (311 N. Second Ave.
Siler City, N.C. 27344
Failure to return this form is enforceable in accordance with the Sewer Use Ordinance
IWS Short Form
Filename IWS Short Form
Revision Date September 1, 1993

Industrial Waste Survey Short Form
This form has been sent to your business to determine types and sources of wastewater that aie entering the
Silei City WWTP This foim must be completed in accordance with section 27-131 of our Sewer Use
Ordinance (NC Model Section 5 7) Our Sewei Use Ordinance can be examined during normal business
hours at the addiess listed below If you have any question or conceins while completing the form, please
contact Terry Gieen 919-742-4732
Name of Business
—W
Address D� I t I hire
City/State/Zip Code Silef Cdv,, �0
Telephone Cq n t Fax
Number ofEnnployees -- —-- - -
What Standard Industrial Classification (SIC) Code(s) do you repoit under
3as-t, =--- , - - - - , ----
Briefly describe your business include pro ucts manufactured or sere ces perfoimed
C,C)rn o, (Ire 1 �-c IQ nlnl lfac,�C f CTT& razz
Please list all watei uses and approximate volume used in gallons per day foi each use, including facility
washdown water
Water Use
Volume Used (gallons pei
day)
Process �• t 11- Dl -C.
01 al
a ho+ a%x
rW C a or
Faciht Washdown
Domes tr bathroom , cafeteria)
Total]
Our Sewer Use Ordinance requn es that an Authorized Representative of the User sign all reports to the Sewer
Authority Authorized Representative is defined as a Person iesponsible for Principle Business decisions or
other policy decisions foi the facility
To the Beknowledge the information on this foam is true and accurate,
LSiggjnatuie;l�����Date 2 -
Tit �' S
Return this form by: February 10, 2018 to: Terry Green, Director of Public Works & Utilities
Town of Siler City
P.O. Box 769 (311 N. Second Ave.
Siler City, N.C. 27344
Failure to return this form is enforceable in accordance with the Sewer Use Ordinance
IWS Short Form
Filename IWS Short Form
Revision Date September 1, 1993
�G

Industrial User Wastewater Survey
& Permit Application
COVER PAGE
Company Name
Name of responsible person on site at the facility authorized to represent the
Name of alternative on site person familiar with the day to day operations,
company in official dealings with the Sewer Authority and/or the City
environmental permitting requirements, monitoring, record keeping, and
✓p j � r �`'� f r� 1l
l(
!f
data management
Title a 9C
Years with firm7
Title
Years with firm
Phone # q,, rC�-7*J- _ �j
Fax # /a°��j ��� �(
G 6 lJ
Phone #
Fax #
Physical street address of facility
Official mailing address, if different Note if same
33D S PO
City
State /V(—
ZtpP'4-41
City
State
Zip
The information provided by you on this questionnaire serves two functions:
1. The information is used to determine if your facility needs an Industrial
User Pretreatment Permit (IUP) for the discharge of wastewater to the
local sewer.
2. If an Industrial User Pretreatment Permit (IUP) is required, this survey
serves as the application for an Industrial User Pretreatment Permit (NP).
Requests for confidential treatment of information provided on this form shall be governed by
procedures specified in 40 CFR Part 2. In accordance with Title 40 of the Code of Federal Regulations
Part 403, Section 403.14 and the Local Sewer Use Ordinance (SUO), information and data provided in
this questionnaire which identifies the content, volume and frequency of discharge shall be available to
the public without restriction.
This is to be signed by an authorized official of your firm, as defined in the Local Sewer Use Ordinance or the NC Model
Sewer Use Ordinance, Section 12, after completion of this form
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 upon 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/or imprisonment for
knowing violations.
Signature of Authorized Representative Date
listed above (seal if
Title IU Wastewater Survey & Permit Application
File name https //files nc gov/ncdeq/Water Quality/Surface Water Protectlon/PERCS/Industrlal Waste Survey
Information/Industrial Wastewater Survey & IUP Permit Application (Long Form).docx
Revision date 12/30/97 Page 1 of 208

Industrial User Wastewater Survey
& Permit Application
1. Provide a brief narrative description of the type of business, manufacturing
processes, or service activities your firm conducts at this site.
a'� f :5
2. List the primary products produced at this facility:
3. List raw materials and process additives used:
tjC)
4. Are biocides added to any water discharged to the POTW,
if yes describe:
Yes
No
5. Describe weekly production schedule, including shifts worked per day,
employees per shift, and primary operation during shift.
7& 3 Oa-- q, 1 5n
6. Production process is: Check, if all continuous
Check, if all batch
If both please enter, % continuous = `vd °Io % Batch = tv o %
Title N Wastewater Survey & Permit Application
File name https //files nc gov/ncdeq/Water Quality/Surface Water Protectlon/PERCS/Industnal Waste Survey
Information/Industnal Wastewater Survey & IUP Permit Application (Long Form).docx
Revision date 12/30/97 Page 2 of 208

Industrial User Wastewater Survey
& Permit Application
7. Does production vary significantly (+- 20 %) by season. Describe.
Yes
No
8. Are any significant (+- 20 %) changes 1n production that will affect wastewater
discharge expected in the next 5 years. If yes, please describe.
Yes
No (/
9. List all current waste haulers. Give name, address, phone numbers, volume and
materials hauled off. w�
10. Attach a copy of laboratory analyses performed in the last year on the wastewater
discharge(s) from your facilities. Summarize data on the attached Data Summary
Form.
11. Attach sketch or schematic showing sampling points and all connections to the sewer.
12. Complete the Wastewater Pollutants Checklist attached to this Survey.
Title N Wastewater Survey & Pernut Application
File name https //files nc gov/ncdeq/Water Quality/Surface Water Protectlon/PERCS/Industrlal Waste Survey
Information/Industrial Wastewater Survey & IUP Permit Application (Long Form).docx
Revision date 12/30/97 Page 3 of 208

Industrial User Wastewater Survey
& Permit Application
13. Do you have, or have you ever applied for, been issued, or been denied
an NPDES permit to discharge to the surface waters or storm sewers of
North Carolina? If yes, list all other NPDES permits, permit numbers,
dates, and names used to apply for them, or reason denied.
If yes Permit , #, date, applicant name
If yes Pernut, #, date, applicant name
Yes
No
14. Do you have, or have you ever applied for or been issued an Industrial
User Pretreatment Permit (IUP) to discharge wastewater to the sewer
collection system. If yes, list all other 1UP permits, permit numbers,
dates, and names used to apply for them.
If yes Pernut , #, date, applicant name
If yes Permit , #, date, applicant name
Yes
No V
15. Do you have, or have you ever applied for or been issued any other
Environmental Permits (for example; air, RCRA, groundwater,
stormwater, general, Non -Discharge, septic tank, etc.). If yes, list all
other permits, ermit numbers, dates, and names used to apply for th
If yes Permit type, #, date, applicant name
If yes Pernut type, #, date, applicant name
If yes Permit type, #, date, applicant name
,in.
Yes
No
16. Is a Spill Prevention Control and Countermeasure (SPCC) Plan
prepared for this facility?
Yes
No ✓
17. Is a Spill /Slug Control Plan required by the POTW, prepared for this
facility?
Yes
No
Title N Wastewater Survey & Permit Application
File name https Hfiles ne gov/ncdeq/Water Quality/Surface Water Protection/PERCS/Industrial Waste Survey
Information/Industrial Wastewater Survey & IUP Permit Application (Long Form).docx
Revision date 12/30/97 Page 4 of 208

Industrial User Wastewater Survey
& Permit Application
18 Do you have any underground storage tanks at your facility? If yes, list
contents and volume of each tank.
Yes
No
19. Do you have any above ground storage tanks at your facility? If yes,
for each tank, list the contents, volume, whether the tank has any spill
prevention or containment devices, such as dikes, and procedures for
draining any containment devices.
Yes # of Tanks
No
Title N Wastewater Survey & Permit Application
File name https //files nc gov/ncdeq/Water Quality/Surface Water Protectlon/PERCS/Industrlal Waste Survey
Information/Industrial Wastewater Survey & IUP Permit Application (Long Form).docx
Revision date 12/30/97 Page 5 of 208

Industrial User Wastewater Survey & Permit Application
PART II, Water Supply, Use, & Disposal Worksheet:
4
6.
7.
8.
9
Water Used for:Av
Water
Source(s)
gal/day
Max
gal/day
M
e
a
S
u
re
d
E
st
i
in
at
a
d
Di
Disposal
Method(s)
Avg.Max.
gal/day
gal/day
M
e
a
s
u
re
d
E
st
i
in
at
e
d
Process water
Washdown water
Water into product
Air Quality Permitted units
Domestic - toilets, drinking, cafe
Cooling water, Process NON -Contact
Boiler / Cooling tower blowdown
Cooling water, HVAC
Other:
(see Source List below)
(see Disposal List below)
�`� 4
Totals =>
Totals =>
Typical Water Sources:
1. City / Public supply
2. Private wells, drinking
3. Groundwater remediation wells
4. Private ponds
5 Surface waters of NC, please identify
6. Include others if applicable
Possible Water Disposal Methods
1. Sanitary sewer, with pretreatment
2. Sanitary sewer, without pretreatment
3. Storm sewer
4. Surface waters of NC
5. Evaporation
6. Land applied
7. To groundwater
8 Septic Tank
9. Waste Haulers (identify)
Title N Wastewater Survey & Permit Application
File name https /files nc gov/ncdeg/Water Quality/Surface Water Protection/PERCS/Industrial Waste Survey Information/Industrial Wastewater Survey & IUP
Permit Application (Long Form).docx
Revision date 12/30/97 Page 6 of 208

PART III, PRETREATMENT FACILITIES:
Are there any pretreatment devices or processes used for treating wastewater
before being discharged to the sewer? Check all that are present, and describe.
No pretreatment facilities =>
1 Flow equalization Aerated equalization =>
NON -Aerated equalization =>
Total volume of equalization (million gal.) =>
2 Activated Carbon Yes
3. Activated Sludge Yes
4. Air Stripping Yes
5. Centrifugation Yes
6. Chemical Precipitation Yes
7 Chlorination Yes
8 Cyanide Destruction Yes
9 Cyclone Yes
10. Dissolved Air Floatation Yes
11. Filtration Yes
12 Flocculation Yes
13 Grease Trap Yes
14. Grit Removal Yes
15. Ion Exchange Yes
16. Neutralize, pH adjust Yes
17 Other Biological Treatment Yes
18 Ozonation Yes
19 Reverse Osmosis Yes
20. Screening Yes
21. Sedimentation Yes
22. Septic Tank Yes
23. Silver Recovery Yes
24. Solvent Separation Yes
25 Spill protection Yes
List any others.
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
v
Describe any, if present
Title N Wastewater Survey & Penrut Application
File name https //files nc gov/ncdeq/Water Quality/Surface Water Protectlon/PERCS/Industrial Waste Survey
Information/Industrial Wastewater Survey & IUP Permit Application (Long Form).docx
Revision date 12/30/97 Page 8 of 208

10. Water into Product
11. Include others, if applicable
Title N Wastewater Survey & Permit Application
File name https //ales nc gov/ncdeq/Water Quality/Surface Water Protection/PERCS/Industrial Waste Survey Information/Industrial Wastewater Survey & IUP
Permit Application (Long Form).docx
Revision date 12/30/97 Page 7 of 208

PART IV, CATEGORICAL INFORMATION:
When were operations started at this facility Facility start update I I q 2 b
2. List all Standard Industrial Classification (SIC) codes for your facility.
These may be found on State Unemployment forms, tax forms,
accounting records, or from the Chamber of Commerce.
UW maAjpj��y
3. Has this facility ever been considered a Categorical Industrial User
(CLU) as described by the Code of Federal Regulations (40 CFR)?
If yes, give complete 40 CFR number =>
No
4. Are any other facilities owned and/or operated by your company
permitted as Categorical Industrial Users (CIUs) as described by the
Code of Federal Regulations (40 CFR)?
If yes please give name(s), location, and 40 CFR number.
Yes
No
Title N Wastewater Survey & Pernut Application
File name https //files nc gov/ncdeq/Water Quality/Surface Water Protectlon/PERCS/Industrlal Waste Survey
Information/Industrial Wastewater Survey & IUP Permit Application (Long Form).docx
Revision date 12/30/97 Page 9 of 208

PART IV, CATEGORICAL INFORMATION:
(continued)
5. Check any activities listed below that are performed at your facility:
Check
40
Industrial Activity
Check
I
40
Industrial Activity
below
CFR#
below
CFR#
Title IU Wastewater Survey & Permit Application
File name https //files nc gov/ncdeq/Water Quality/Surface Water Protectlon/PERCS/Industrlal Waste Survey
Information/Industrial Wastewater Survey & IUP Permit Application (Long Form).docx
Revision date 12/30/97 Page 10 of 208
467 Aluminum Forming
427 Asbestos Manufacturing
461 Battery Manufacturing
431 Builders paper & board mulls
407 Canned & preserved fruits & veg
408 Canned & preserved seafood
458 Carbon black Manufacturing
411 Cement Manufacturing
437 Centralized Waste Treatment
434 Coal Mining
465 Coil Coating
468 Copper Forrruung
405 Dairy products processing
469 Electrical, electronic components
413 Electroplating
457 Explosives Manufacturing
412 Feedlots
424 Ferro allay Manufacturing
418 Fertilizer Manufacturing
464 Foundries, Metal Mold & Casting
426 Glass Manufacturing
406 Grain mulls
454 Gum & Wood Chemicals Mfg
460 Hospitals
447 Ink formulating
415 Inorganic chemical Manufacturing
420 Iron & Steel Manufacturing
425 Leather Tanning & Finishing
432 Meat products
433 Metal finishing
464 Metal molding and casting
436 Mineral mining and processing
471 Nonferrous Metal, Form & Powders
421 Nonferrous Metals Manufacturing
414 OCPSF, Organic Chemicals, Plastics,
& Synthetic Fiber Manufacturing
435 Oil & gas extraction
440 Ore mining and dressing
446 Paint formulating
443 Paving and roofing materials Mfg
455 Pesticide Manufacturing
419 Petroleum Refining
439 Pharmaceutical Manufacturing
422 Phosphate Manufacturing
459 Photographic supplies
463 Plastics molding and forming
466 Porcelain enameling
430 Pulp, paper, and paperboard
428 Rubber Manufacturing
417 Soap & Detergent Manufacturing
423 Steam Electric power Generation
409 Sugar processing
410 Textile Mills
429 Timber products processing
442 Transportation Equipment Cleaning
Others
Title IU Wastewater Survey & Permit Application
File name https //files nc gov/ncdeq/Water Quality/Surface Water Protectlon/PERCS/Industrlal Waste Survey
Information/Industrial Wastewater Survey & IUP Permit Application (Long Form).docx
Revision date 12/30/97 Page 10 of 208

Wastewater Pollutant Checklist
Chemical Name
EPA
Check if
Check if
Check if
Check if
Concentration
34616
Storet
Present at
Absent at
Present in
Absent in
in Discharge,
4 -Nitro henol
Code
Facility
Facility
Discharge
Discharge
if Known
34621
Acenaphthene
03405
Acenaphthylene
34200
Anthracene
(m /1)
Acid Extractable Organics
2 -Chloro henol
34586
2 4-Dlchloro henol
34601
2 4-Dlmeth 1 henol
34606
2 4-Dinitro henol
34616
2 -Meth 1-4 6-dlnitro henol
34657
4 -Chloro -3 -meth 1 henol
34452
2-Nitrophenol
34591
4 -Nitro henol
34646
Pentachlorophenol
39032
Phenol
34694
2 4 6-Tnchloro henol
34621
Base Neutral Organics
1 2 4-Tnchlorobenzene
34551
1,2 -Dichlorobenzene
34536
1 2 -Di hen lh drazlne
34346
1,3 -Dichlorobenzene
34566
1,4 -Dichlorobenzene
34571
2 4-Dlnitrotoluene
34611
2 6-Dlnitrotoluene
34626
2-Chloronaphthalene
34581
3,3-Dlchlorobenzidlne
34631
4-Bromophenyl phenyl ether
34636
4-Chlorophenyl phenyl ether
34641
Acenaphthene
03405
Acenaphthylene
34200
Anthracene
34220
Benzidine
39120
Benzo (a) anthracene
34526
Benzo (a) pyrene
34247
Benzo (b) fluoranthene
34230
Benzo (gh1) perylene
34521
Benzo (k) fluoranthene
34242
Bls(2-chloroethoxy) methane
34278
Bis(2-chloroethyl) ether
34273
Bis(2-chlorolsopropyl) ether
34283
B1s(2-ethylhexyl) phthalate
39100
Butyl benzyl phthalate
34292
Chrysene
1 34320
Di -n -butyl phthalate
39110
1
Title N Wastewater Survey & Permit Application
File name https //files nc gov/ncdeq/Water Quahty/Surface Water Protectlon/PERCS/Industrlal Waste Survey
Information/Industrial Wastewater Survey & IUP Permit Application (Long Form).docx
Revision date 12/30/97 Page 11 of 208

Wastewater Pollutant Checklist
Chemical Name
EPA
Check if
Check if
Check if
Check if
Concentration
34341
Storet
Present at
Absent at
Present in
Absent in
in Discharge,
Hexachlorobutadiene
Code
Facility
Facility
Discharge
Discharge
if Known
34403
Iso horone
34408
N -nitroso -di -n- ro lamine
34428
N-nitrosodimeth lamine
(m /1)
Base Neutral Organics (continued)
Di-n-oct 1 phthalate
34596
Dibenzo (a,h) anthracene
34556
Diethyl plithalate
34336
Dimethyl plithalate
34341
Fluoranthene
34376
Fluorene
34381
Hexachlorobenzene
3970
Hexachlorobutadiene
34391
Hexachloroc clo entadiene
34386
Hexachloroethane
34396
Indeno(1,2,3-cd) pyrene
34403
Iso horone
34408
N -nitroso -di -n- ro lamine
34428
N-nitrosodimeth lamine
3443E
N-nitrosodl hen lamine
34433
Naphthalene
34696
Nitrobenzene
34447
Phenanthrene
34461
Pyrene
34469
Metals
Aluminum
01104
Antimony
01097
Arsenic
01002
Beryllium
01012
Cadmium
01027
Chromium
01034
Copper
01042
Lead
01051
Mercury
71900
Molybdenum
01062
Nickel
01067
Selenium
01147
Silver
01077
Thalium
00982
Zinc
01092
Title N Wastewater Survey & Permrt Application
File name https //files nc gov/ncdeq/Water Quality/Surface Water Protectlon/PERCS/Industrlal Waste Survey
Information/Industrial Wastewater Survey & IUP Permit Application (Long Form).docx
Revision date 12/30/97 Page 12 of 208

Wastewater Pollutant Checklist
Chemical Name
EPA
Check if
Check if
Check if
Check if
Concentration
00951
Storet
Present at
Absent at
Present in
Absent in
in Discharge,
2-Chloroeth 1 vinyl ether
Code
Facility
Facility
Discharge
Discharge
if Known
34030
Bromodichloromethane
32101
Bromofonm
32104
Bromomethane
(m /1)
Other Inorganics
Banum
01007
Chloride
00940
Cyanide
00720
Fluoride
00951
Purgeable Volatile Organics
1 1 1 -Trichloroethane
34506
1 1,2,2 -Tetrachloroethane
34516
1 1 2-Tnchloroethane
34511
1 1-Dichloroethane
34496
1 1-Dichloroeth lene
34501
1 2-Dlchloroethane
34531
1 2-Dichloro ro ane
34541
2-Chloroeth 1 vinyl ether
34576
Acrolein
34210
Acrylonitrile
34215
Benzene
34030
Bromodichloromethane
32101
Bromofonm
32104
Bromomethane
34413
Carbon tetrachloride
32102
Chlorobenzene
34301
Chloroethane
34311
Chloroform
32106
Chloromethane
34418
cis 1 3-Dichloro ro ene
34704
Dibromochloromethane
32105
Eth lbenzene
34371
Methylene chloride
34423
Tetrachloroethylene
34475
Toluene
34010
trans 1 3-Dichloro r0 ene
34699
trans -1 2-Dichloroeth lene
34546
Tnchloroeth lene
39180
Tnchlorofluoromethane
34488
Vinyl chloride
39175
Others
Title N Wastewater Survey & Permit Application
File name https //files nc gov/ncdeq/Water Quality/Surface Water Protection/PERCS/Industrial Waste Survey
Information/Industrial Wastewater Survey & IUP Permit Application (Long Form).docx
Revision date 12/30/97 Page 13 of 208

Data Summary Form
<= Receiving POTW
<= Receiving NPDES #
<= Specific Sample Location!
i.e., Give IU Name, IUP#, and/or pipe#
Lab => Laboratory performing analysis =>
MDL => Laboratory Method Detection Limits =>
Notes => Notes =>
Q =Flow
BOD
TSS
Ammonia
Conc Results
from Lab
<? mg/1
Conc. Results
from Lab
<? mg/1
Conc. Results
fioin Lab
<? mg/1
Sample
ID, or
Count
Date Notes about Sample
Sample
Collected
M = Metered
E = Estimated
mgd gal/day
1
2
3
4
5
6
7
8
9
10
11
12
etc
TNS => Total number of samples =>
Max. value => Maximum data value (mg/1) =>
Avg. (use 1/2 BDL) => Avg. data value, Include BDL values as 1/2 detection limit =>
Title W Wastewater Survey & Permit Application
File name https Hfiles nc gov/ncdeq/Water Quality/Surface Water Protection/PERCS/Industrial Waste Survey Information/Industrial Wastewater Survey & IUP
Permit Application (Long Form).docx
Revision date 12/30/97 Page 14 of 208

Data Summary Form
<= Receiving POTW
<= Receiving NPDES #
<= Specific Sample Location!
i.e., Give IU Name, IUP#, and/or pipe #
TNS =>
Max. Value =>
Title IU Wastewater Survey & Permit Application
Filename https //files nc gov/ncdeq/Water Quality/Surface Water Protection/PERCS/Industrial Waste Survey Information/Industrial Wastewater Survey & IUP
Permit Application (Long Form).docx
Revision date 12/30/97 Page 15 of 208
Arsenic
Copper
Chromium
Cadmium COD
Copper
Lab =>
MDL =>
Notes =>
Conc. Results
from Lab
<? mg/1
Cone. Results
from Lab
<? mg/1
Conc Results
from Lab
<? mg/1
Conc. Results Cone. Results
from Lab from Lab
<? mg/1 <? mg/1
Conc. Results
from Lab
<? mg/l
Sample
ID or
Count
Date Sample
Collected
1
2
3
4
5
6
7
8
9
10
11
12
etc
TNS =>
Max. Value =>
Title IU Wastewater Survey & Permit Application
Filename https //files nc gov/ncdeq/Water Quality/Surface Water Protection/PERCS/Industrial Waste Survey Information/Industrial Wastewater Survey & IUP
Permit Application (Long Form).docx
Revision date 12/30/97 Page 15 of 208

Avg. (use 1/2 BDL) _>
Data Summary Form
<= Receiving POTW
<= Receiving NPDES #
<= Specific Sample Location!
i.e., Give IU Name, IUP#, and/or pipe #
TNS =>
Title N Wastewater Survey & Permit Application
File name https /ales nc gov/nedeq/Water Quality/Surface Water Protection/PERCS/Industrial Waste Survey Information/Industrial Wastewater Survey & IUP
Permit Application (Long Form).docx
Revision date 12/30/97 Page 16 of 208
Cyanide
Lead
Mercury
Nickel
Silver
Zinc
Lab =>
MDL =>
Notes =>
Conc. Results
from Lab
<? mg/1
Conc. Results
from Lab
<? mg/1
Conc. Results
from Lab
<? mg/l<?
Conc Results
from Lab
mg/l
Conc. Results
from Lab
<? mg/1
Conc. Results
from Lab
�? mg/1
Sample
ID or
Count
Date Sample
Collected
1
2
3
4
5
6
7
8
9
10
11
12
etc
TNS =>
Title N Wastewater Survey & Permit Application
File name https /ales nc gov/nedeq/Water Quality/Surface Water Protection/PERCS/Industrial Waste Survey Information/Industrial Wastewater Survey & IUP
Permit Application (Long Form).docx
Revision date 12/30/97 Page 16 of 208

Max. Value =>
Avg. (use 1/2 BDL) =>
Data Summary Form
<= Receiving POTW
<= Receiving NPDES #
<= Specific Sample Location!
i.e., Give IU Name, IUP#, and/or pipe #
Title IU Wastewater Survey & Permit Application
File name naps /files nc gov/ncdeq/Water Quality/Surface Water Protect>on/PERCS/Industrial Waste Survey Information/Industrial Wastewater Survey & IUP
Permit Application (Long Form).docx
Revision date 12/30/97 Page 17 of 208
Other
Other
Other
Other
Other
Other
Lab =>
MDL =>
Notes =>
Conc. Results
from Lab
<? mg/1
Conc. Results
from Lab
<? mg/1
Conc. Results
from Lab
<? mg/1
Conc. Results
from Lab
<? mg/l
Conc. Results
from Lab
<? mg/1
Conc Results
from Lab
<? mg/1
Sample
ID or
Count
Date Sample
Collected
1
2
3
4
5
6
7
8
9
10
11
12
etc
Title IU Wastewater Survey & Permit Application
File name naps /files nc gov/ncdeq/Water Quality/Surface Water Protect>on/PERCS/Industrial Waste Survey Information/Industrial Wastewater Survey & IUP
Permit Application (Long Form).docx
Revision date 12/30/97 Page 17 of 208

TNS =>
Max. Value =>
Avg. (usel/2 BDL) =>
Title N Wastewater Survey & Permit Application
File name https ufles nc gov/ncdeq/Water Quality/Surface Water Protection/PERCS/Industrial Waste Survey Information/Industrial Wastewater Survey & IUP
Permit Application (Long Form).docx
Revision date 12/30/97 Page 18 of 208

Industrial User Wastewater Survey
& Permit Application
Part V, Waste Reduction Information :
State Pretreatment Rule 15A NCAC 2H.0916 (c)(1)(M) requires Significant Industrial
Users to include a description of current and projected waste reduction (pollution
prevention) activities. The codes listed are standard EPA codes found on Toxic Release
Inventory and other environmental forms. Please check all applicable codes for your
facility related to wastewater discharge.
Current Proiected Code Description
Title N Wastewater Survey & Permit Application
File name https //files nc gov/ncdeq/Water Quality/Surface Water Protectlon/PERCS/Industrlal Waste Survey
Information/Industrial Wastewater Survey & IUP Permit Application (Long Form).docx
Revision date 12/30/97 Page 19 of 18
W13
Improved maintenance scheduling recordkee in , or procedures
LW14
Changed production schedule to minimize equipment and feedstock
changeovers
W19
Other changes in operating ractices (explain briefly in comments)
W21
Instituted procedures to ensure that materials do not stay in inventory
beyond shelf -life
W22
Began to test outdated material -continue to use if still effective
W23
Eliminated shelf -life requirements for stable materials
W24
Instituted better labeling procedures
W25
Instituted clearinghouse to exchange materials that would otherwise
be discarded
W29
Other changes in Inventory control (explain briefly in comments)
W31
Improved storage or stacking procedures
W32
Improved procedures for loading, unloading and transfer operations
W33
Installed overflow alarms or automatic shutoff valves
W34
Installed secondary containment
W35
Installed vapor recovery systems
W36
Implemented inspection or monitoring program of potential spill or
leak sources
W39
Others ill and leak prevention (explain briefly in comments)
W41
Increased purity of raw materials
W42
Substituted raw materials
W49
Other raw material modifications (explain briefly in comments)
W51
Instituted recirculation within a process
Title N Wastewater Survey & Permit Application
File name https //files nc gov/ncdeq/Water Quality/Surface Water Protectlon/PERCS/Industrlal Waste Survey
Information/Industrial Wastewater Survey & IUP Permit Application (Long Form).docx
Revision date 12/30/97 Page 19 of 18

Industrial User Wastewater Survey
& Permit Application
Current
Projected
Code
Description
W52
Modified equipment, la out, or piping
W53
Use of a different process catalyst
W54
Instituted better controls on operating bulk containers to minimize
discarding of empty containers
W55
Changed from small volume containers to bulk containers to
minimize discarding of empty containers
W58
Other process modifications (explain briefly in comments)
W59
Modified stripping / cleaning equipment
W60
Changed to mechanical stripping / cleaning devices (from solvents or
other materials)
W61
Changed to aqueous cleaners ( from solvents or other materials)
W62
Reduced the number of solvents used to make waste more amenable
to recycling
W63
Modified containment procedures for cleaning units
W64
Improved draining procedures
W65
Redesigned parts racks to reduce dra out
W66
Modified or installed rinses stems
W67
Improved rinse equipment desi n
W68
Improved rinse equipment oeration
W71
Other cleaning and degreasing operation (explain briefly in comments)
W72
Modified spray systems orequipment
W73
Substituted coating materials used
W74
Improved application techniques
W75
Changed from spray to others stem
W78
Other surface preparation and finishing (explain briefly in comments)
W81
Changed product specifications
W82
Modified design or composition of product
W83
Modified packaging
W89
Other product modifications (explain briefly in comments)
W99
Other (specify in comments )
Comments (Please list corresponding code)
Title N Wastewater Survey & Pernut Application
File name https //files nc gov/ncdeq/Water Quality/Surface Water Protectlon/PERCS/Industrlal Waste Survey
Information/Industrial Wastewater Survey & IUP Permit Application (Long Form).docx
Revision date 12/30/97 Page 20 of 208